Variant survivin vaccine for treatment of cancer

ABSTRACT

The invention concerns a variant (double mutant form) of the survivin polypeptide; nucleic acid molecules encoding the survivin variant; antigen presenting cells (APCs) such as dendritic cells, or APC precursors, comprising the variant survivin polypeptide or encoding nucleic acid sequence; and methods for treating a malignancy, such as myeloma, or for inducing an immune response, utilizing a variant survivin polypeptide, nucleic acid molecule, or APC.

CROSS-REFERENCE TO RELATED APPLICATIONS

The present application is a divisional of U.S. application Ser. No.16/548,989, filed Aug. 23, 2019, which is a continuation of U.S.application Ser. No. 15/568,967, filed Oct. 24, 2017, which is theNational Stage of International Application No. PCT/US2016/031390, filedMay 7, 2016, which claims the benefit of U.S. Provisional ApplicationSer. No. 62/158,341, filed May 7, 2015, which is hereby incorporated byreference herein in its entirety, including any figures, tables, nucleicacid sequences, amino acid sequences, or drawings.

GOVERNMENT SUPPORT

This invention was made with government support under grant numberCA078810 awarded by the National Institutes of Health. The governmenthas certain rights in the invention.

BACKGROUND OF THE INVENTION

Survivin is a small protein and tumor associated antigen expressed inmultiple myeloma. Survivin normally functions as an apoptosis inhibitor,via spindle microtubule and mitotic checkpoint regulation (1). It is apotential target for immunotherapy since it is highly expressed in manycancers (2-4), it is linked to worse prognosis in both solid andhematologic tumors, and it is undetectable in almost all normal adulttissues (5). Survivin is overexpressed in myeloma cell lines and itsexpression in primary myeloma cells is associated with poor prognosis,disease progression, and drug resistance (6, 7).

CD8+ T cells specific for survivin have been demonstrated in myelomapatients (8), and survivin-specific CTL responses were generated in vivoin tumor-bearing mice (9-11). For malignant melanoma patients receivinga MHC class I restricted peptide vaccine against survivin, both responseto therapy and overall survival were associated with a CD8+ T cellresponse against survivin (12). Present knowledge of human immuneresponse against survivin is almost entirely based upon the induction ofcytotoxic CD8+ T cell responses using vaccines or clonotype analysisusing single HLA-Class I peptides. Little is known about important CD4+helper T cell responses against survivin, which are essential for anoptimal anti-tumor immune response (13, 14). Cancer patients can havesurvivin-specific CD4+ T cells (15-17) and robust CD4+ responses may begenerated with survivin HLA-class II restricted peptide vaccines incancer patients (18, 19). CD4+ T cells can reject tumors in the absenceof CD8+ T cells (20) and provide primary anti-tumor immune responsesimportant for immunosurveillance (21). The spontaneous CD4+ responseagainst survivin in myeloma patients has not been characterized, andmust be understood to identify vaccine strategies against aggressivesurvivin expressing myeloma.

Prior evaluation of T cell immune responses against survivin, and mosttherapeutic survivin cancer vaccines, has relied upon identification ofT cells specific for HLA restricted peptides. This strategy has severallimitations. Many peptides can be generated from the entire protein.Each peptide is restricted by one or few HLA molecules for presentationto immune cells and HLA molecules are encoded by 15 distinct genes thatare the most polymorphic in the entire genome. Therefore, because HLAgenes vary widely among people, the probability of one peptide inducingan immune response is low and the breadth of the response is extremelynarrow. Survivin-derived peptide pools can overcome these limitationsand allow study of the immune response against survivin (22).

BRIEF SUMMARY OF THE INVENTION

The present invention concerns variant survivin polypeptides, nucleicacid molecules encoding the variant survivin polypeptides, antigenpresenting cells (APCs) comprising the variant survivin polypeptide orencoding nucleic acid sequence, and compositions containing any of theforegoing, useful as vaccines for the treatment of existing malignanciesand preventing or delaying the onset of malignancies, and for inducing adesired immune response (e.g., a survivin-reactive CD4+ T cellresponse).

In one approach, APCs such as autologous dendritic cells may begenerated from their precursors in bone marrow or peripheral bloodmononuclear cells from the subject suffering from the malignancy,transfecting the cells with a nucleic acid to produce a variant survivinpolypeptide, and then infusing the cells back into the subject.Advantageous, portions of the variant survivin polypeptide are presentedby the APC. The APC-based vaccination can act as an antigen deliveryvehicle as well as a potent adjuvant, resulting in anti-tumor immunity.

Accordingly, aspects of the invention are directed to (i) a variantsurvivin polypeptide, (ii) nucleic acid molecules encoding thepolypeptides (and expression constructs comprising the nucleic acids),and (iii) APCs comprising the variant survivin polypeptide or nucleicacid sequence encoding a variant survivin polypeptide, wherein thevariant survivin polypeptide comprises at least consecutive amino acids16-87 (N-terminal zinc-binding baculovirus inhibitor of apoptosisprotein repeat (BIR) domain) of the human wild-type survivin polypeptide(SEQ ID NO:1) modified to have an amino acid at position 34 which isother than threonine and an amino acid at position 84 which is otherthan cysteine, relative to the human wild-type survivin polypeptide, andwherein the variant survivin polypeptide:

(a) comprises a 142-amino acid sequence having at least 80% sequenceidentity to the human wild-type survivin polypeptide (SEQ ID NO:1), or

(b) is a subsequence (fragment) of the human wild-type survivinpolypeptide (SEQ ID NO:1).

In some embodiments, one or both of the amino acids at position 34 andat position 84 are nonpolar amino acids. In some embodiments, one orboth of the amino acids at position 34 and at position 84 are alanine.

In some embodiments, the variant survivin polypeptide comprises afull-length mammalian wild-type survivin polypeptide having an aminoacid at position 34 which is other than threonine, and an amino acid atposition 84 which is other than cysteine, such as set forth as SEQ IDNO:2 or a mammalian homolog thereof.

In some embodiments, the variant survivin polypeptide comprises thefull-length human wild-type survivin polypeptide having an amino acid atposition 34 which is other than threonine, and an amino acid at position84 which is other than cysteine, as set forth as SEQ ID NO:2.

In some embodiments, the variant survivin polypeptide further includesat least consecutive amino acids 6-10, consecutive amino acids 89-97(linker region), and consecutive amino acids 97-141 (coiled coil domain)of the human wild-type survivin polypeptide (SEQ ID NO:1).

Another aspect of the invention concerns a composition comprising APCsof the invention; and a pharmaceutically acceptable carrier. Thecomposition may include further components, such as an adjuvant or otheranti-cancer agents, such as a chemotherapeutic or immunotherapeuticagent, or an antigen (e.g., a tumor-associated antigen).

Another aspect of the invention concerns a method for treating amalignancy, comprising administering to a subject in need of treatmentan effective amount of antigen presenting cells of the invention. Insome embodiments, the malignancy is myeloma.

BRIEF DESCRIPTION OF THE DRAWINGS

FIGS. 1A-1C. Healthy donor CD4+CD25− T cells proliferate and secreteIFN-gamma in response to survivin peptide pools presented by autologousdendritic cells. 1×10⁵ Purified CD4+CD25− cells were stimulated for 6days with 1×10⁴ autologous DCs loaded with CMV peptide pool (DC:CMV)positive control, survivin peptide pool (DC:survivin), or unloaded(DC:null) negative control. Proliferation (FIG. 1A) and IFN-gammasecretion (FIG. 1B) were elicited by DC:survivin, figures represent themean of three independent experiments from different healthy donors anderror bar represents standard error of the mean. For 10 consecutiveevaluable healthy donors, a stimulation index was calculated (FIG. 1C)[1×10⁵ CD4+CD25− T cells stimulated with 1×10⁴ DC:survivin(numerator)/Mean of >=10 DC:null stimulated T cell controls(denominator)]. Box and whiskers represents multiple stimulation indices(Line=Mean, Box=25%-75% CI, Whiskers=minimum and maximum) for eachdonor. *p<0.05.

FIGS. 2A and 2B. Limiting dilution analysis (LDA) determines thefrequency of survivin-reactive CD4+CD25− T cells in normal human blood.Serially diluted, purified CD4+CD25− T cells were stimulated withautologous DC:survivin in the presence of exogenous IL-2. Each LDA wasperformed with a minimum of 10 replicates per cell concentration. (FIG.2A) Log-fraction plot of the LDA of survivin specific CD4+CD25− T cellsboth before and after expansion with DC:survivin. The slope representslog-active cell fraction, bold lines represent frequency estimates, andnon-bold lines show 95% CIs based on the likelihood ratio test ofsingle-hit model. One out of 44,907 cells were estimated to respond tothe survivin peptide pool before expansion (Before). Separately,CD4+CD25− T cells from the same donor were expanded using DC:survivinand exogenous IL-2 for 12 days. Cells were collected, enumerated, andrested without cytokines for 2 days. Repeat LDA after expansiondemonstrated enrichment for survivin specific T cells to 1 out of 383(After), p<0.0001. The results are representative of 2 independentexperiments from separate healthy donors. (FIG. 2B) LDA was validated bylabeling un-stimulated CD4+CD25− T cells with CTV (cell trace violet)prior to expansion with DC:survivin and exogenous IL-2. After 12 days, Tcells were flow sorted into CD4+CTV− (replicated) and CD4+CTV+(non-replicated), then rested for 2 days without cytokines. 2.5×10³ CD4+T cells were stimulated with DC:survivin or DC:HIV (irrelevant) peptidepool for 24 hours. *=p<0.05 by t test, error bars indicate the standarddeviation. The results are representative of two independent experimentsfrom separate healthy donors.

FIGS. 3A-3C. Myeloma patients harbor survivin specific CD4+CD25− T cellswhich respond to survivin peptide pool loaded autologous DCs. FIG. 3A:The survivin-reactive CD4+CD25− precursor frequency for 12 consecutivemyeloma patients was determined. Myeloma patients survivin-reactivecells, as a % of total CD4+CD25− cells, were less than that ofconsecutive healthy donors (p=0.02, non-parametric t-test). FIGS. 3B-3C:Myeloma patient CD4+CD25− cells were expanded using DC:survivin asdescribed. The survivin-reactive cell frequency (FIG. 3B) and the totalnumber of survivin-reactive cells (FIG. 3C) was significantly increased(graph shows results of 5 myeloma patients with survivin-reactive cellscalculated by LDA both before and after peptide pool expansion).(Line=Mean, Box=25%-75% CI, Whiskers=minimum and maximum) *p<0.05 bynon-parametric t-test.

FIGS. 4A and 4B. Multiple myeloma tumors express survivin mRNAtranscripts which inversely correlate with survivin-reactive CD4+ T cellfrequency. FIG. 4A: CD138+ T cells were purified from myeloma patientbone marrow aspirates. mRNA transcripts for survivin were normalized toGAPDH. FIG. 4B: mRNA expression inversely correlates to the de-novosurvivin-reactive CD4+CD25− T cell precursor frequency as calculated byLDA. (p=0.0028 and r=−1.0 by Spearman nonparametric correlationanalysis).

FIGS. 5A and 5B. A full length survivin protein vaccine expandssurvivin-specific CD4+ cells even in patients with a lowsurvivin-reactive precursor frequency. FIGS. 5A-5B: An adenoviralconstruct was used to infect autologous myeloma patient DCs which leadsto expression of a full-length mutant survivin protein. PatientCD4+CD25− T cell survivin-reactive frequency was calculated by LDAbefore and after 12 day co-culture with DC:ad-ms. The survivin vaccineincreases both the frequency of survivin-reactive CD4+ cells (FIG. 5A)and the absolute number of survivin-reactive cells (FIG. 5B). *=p<0.05by paired ratio t-test.

FIGS. 6-8. FIGS. 6-8 demonstrate that the adenoviral construct used inthe study can be used to overexpress survivin in DCs. Dendritic cellswere from healthy donor peripheral blood and infected with eithercontrol (Ad-CMV-GFP) or Ad-survivin (20,000 viral particles per cell)for 48 hr. Survivin was evaluated by Western Blot. MM lysate is apositive control showing survivin protein in multiple myeloma cells.FIG. 8 shows the results of another experiment similar to FIGS. 6 and 7,but for comparison with several different tumors were used as positivecontrols. PC9 and A549 are two lung carcinoma cell lines.

FIG. 9. Treatment schema using survivin variant polypeptide and Prevnar13 (Prevnar 13, Pneumococcal 13-valent Conjugate Vaccine (DiphtheriaCRM197 Protein)) with autologous hematopoietic transplant.

FIGS. 10A and 10B. Survivin peptide pools co-cultured with myelomapatient PBMCs elicit IFN-gamma release and proliferation. Myelomapatient PBMCs were collected by apheresis before autologous transplant,then were co-cultured with survivin peptide pool or a negative controlpool (HIV). After 6 days of co-culture in the presence of IL-7 andIL-15, supernatant was collected for IFN-gamma ELISA (FIG. 10A), orproliferation was measured by 8 hour thymidine incorporation (FIG. 10B).

FIGS. 11A and 11B. Myeloma patients' survivin specific CD4+CD25− T cellscan be directly quantified and inversely correlate with tumor survivinmRNA expression. FIG. 11A: The survivin reactive CD4+CD25− precursorfrequency for 12 consecutive myeloma patients was determined. Myelomapatients survivin reactive cells, as a % of total CD4+CD25−) cells wereless than that of consecutive healthy donors (p=0.02, non-parametrict-test). FIG. 11B: CD138+ T cells were purified from myeloma patientbone marrow aspirates. mRNA transcripts for survivin were normalized toGAPDH. mRNA expression inversely correlates to the survivin reactiveCD4+CD25− T cell precursor frequency as calculated by LDA. (p=0.0028 andr=−1.0 by Spearman nonparametric correlation analysis).

FIGS. 12A and 12B. A full length survivin protein vaccine expandssurvivin specific CD4+ cells even in patients with a low survivinreactive precursor frequency. FIG. 12A: An adenoviral construct was usedto infect autologous myeloma patient DCs which leads to expression of afull length mutant survivin protein (mAd-surv). Patient CD4+CD25− T cellsurvivin reactive frequency was calculated using survivin peptide poolby LDA before and after 12 day co-culture with DC:ad-ms. The survivinvaccine increases both the frequency of survivin reactive CD4+ cells(not shown) and the absolute number of survivin reactive cells. *=p<0.05by paired ratio t-test. FIG. 12B: After T cell stimulation usingmAd-surv, T cells were collected, rested for 2 days, enumerated, andre-stimulated using autologous DCs loaded with survivin peptide pool,irrelevant protein (HIV) peptide pool, or unloaded DCs. Expanded cellsexhibit survivin specificity.

FIGS. 13A and 13B. Vaccination with PCV-13 elicits humoral immuneresponses against pneumococcal serotypes when administeredpre-mobilization and again early post-transplant. FIG. 13A: The relativeincrease in pneumococcal serotype IgG (Day+90 aftertransplant/pre-vaccine) is plotted on the y axis. Pneumococcal 13-valentConjugate Vaccine specific serotypes (open squares) are compared toserotypes not included in the vaccine (open diamonds) for each patient.*=p<0.05 by non-parametric t-test. NS=not significant. FIG. 13B:Absolute IgG levels for each of the pneumococcal serotypes, pre-vaccine(triangles) and day +90 post-transplant (circles). *=p<0.05 bynon-parametric paired t-test.

FIGS. 14A-14D. Vaccination with PCV-13 elicits cellular immune responsesto the CRM197 protein. PBMCs were stained with cell trace violet thenincubated with CRM197 or vehicle control as indicated in the methods.Cells were then harvested and stained for flow cytometry. FIG. 14A: Flowplot was first gated upon live, single cell, CD3+, CD4+ and shows thebest CD4+CTV-IFN-gamma+ response at day +30. FIG. 14B: The % of CD4+cells that divide and express intracellular IFN-gamma (CTV-IFNgamma+ asa % of live single cell CD4) is plotted for each patient (one dot foreach patient) from pre-vaccine to post-transplant (day +30 and day +90).*=p<0.05 by non-parametric t-test. FIG. 14C: Flow plot was first gatedupon live, single cell, CD3+, CD8+ and shows the best CD8+CD107a+response at day +30. FIG. 14D: The % of CD8+ cells that express thecytotoxicity marker CD107a (CD107a+ as a % of live single cell CD8) isplotted for each patient (one dot for each patient) from pre-vaccine topost-transplant (day +30 and day +90). *=p<0.05 by non-parametrict-test.

FIGS. 15A and 15B. Tumor survivin is expressed in myeloma patients'tumors after induction therapy. FIG. 15A: Survivin protein expression.Bone marrow biopsy specimens collected after induction chemotherapy andprior to autologous transplant were evaluated by immunohistochemistryfor the presence of survivin protein. FIG. 15B: Survivin mRNAexpression. CD138+ cells were purified from bone marrow aspiratescollected after induction chemotherapy and prior to autologoustransplant. PCR reveals survivin expression normalized against GAPDHexpression. Dotted line represents the survivin expression (mean+2standard deviations) in PBMCs from healthy donor controls.

FIGS. 16A-16D. Construction and expression of single mutant (T34A)pAd-survivin vectors. (FIG. 16A) Map of pAdTrack CMV and pAdEasyvectors. (FIG. 16B) GFP expression in transduced cultures. HeLa cellswere infected with the indicated pAd vectors at moi of 50 for 8 hours,harvested after 48 hours, and analyzed by fluorescence microscopy. (FIG.16C) Absence of replication-competent adenoviral particles. HeLa cells(8×10⁴) were infected with pAd-T34A or pAdGFP at moi of 1,250 and grownfor 3 days at 37° C. Cell extracts were used to successively infect asecond HeLa cell culture, and cells were analyzed by phase-contrastmicroscopy (Phase) or GFP expression (GFP) after an additional 2-dayperiod. (FIG. 16D) Western blot analysis. Aliquots of HeLa or MCF-7cells were infected with the indicated pAd vectors at MOI of 50,harvested after 48 hours at 37° C., and protein normalized extracts wereanalyzed by Western blotting with an Ab to survivin, XIAP, or controlβ-actin followed by chemiluminescence. Molecular-weight markers inkilodaltons are shown on the left. LITR, left-hand inverted terminalrepeat; MW, molecular weight.

FIG. 17. Flow chart showing processes for preparation of autologous orallogeneic mononuclear cells and apheresis for cryopreservation.

FIG. 18. Flow chart showing processes for thawing and culturing duringdendritic cell production.

FIG. 19. Flow chart showing processes for harvesting and infection ofdendritic cells with Ad-mSurvivin.

FIG. 20. Flow chart showing processes for harvesting of Ad-mSurvivininfected dendritic cells and preparation for infusion.

FIG. 21. Optimization of dendritic cell infection. FIG. 21 shows a rangeof multiplicities of infection (MOI; IFU/cell), centered on an MOI of1,000.

BRIEF DESCRIPTION OF THE SEQUENCES

SEQ ID NO:1 is the full-length amino acid sequence of the humanwild-type survivin with amino acid positions 34 and 84 in bold andunderlined:

MGAPTLPPAWQPFLKDHRISTFKNWPFLEGCAC T PERMAEAGFIHCPTENEPDLAQCFFCFKELEGWEPDDDPIEEHKKHSSG C AFLSVKKQFEELTLGEFLKLDRERAKNKIAKETNNKKKEFEETAKKVRRAIEQLAAMD(UniProtKB Reference No. 015392).

SEQ ID NO:2 is an embodiment of a full-length double mutant of humansurvivin with amino acid substitutions at positions 34 (T→Xaa) and 84(C→Xaa) indicated in bold and underlined, wherein Xaa at position 34 isany amino acid other than threonine and Xaa at position 84 is any aminoacid other than cysteine:

MGAPTLPPAWQPFLKDHRISTFKNWPFLEGCAC Xaa PERMAEAGFIHCPTENEPDLAQCFFCFKELEGWEPDDDPIEEHKKHSSG Xaa AFLSVKKQFEELTLGEFLKLDRERAKNKIAKETNNKKKEFEETAKKVRRAIEQLAAMD.

SEQ ID NO:3 is an embodiment of a full-length double mutant of humansurvivin (T34A and C84A) with amino acid substitutions at positions 34(T→A) and 84 (C→A) indicated in bold and underlined:

MGAPTLPPAWQPFLKDHRISTFKNWPFLEGCAC A PERMAEAGFIHCPTENEPDLAQCFFCFKELEGWEPDDDPIEEHKKHSSG A AFLSVKKQFEELTLGEFLKLDRERAKNKIAKETNNKKKEFEETAKKVRRAIEQLAAMD.

SEQ ID NO:4 is the sequence of a forward primer for the C84A survivinmutant.

SEQ ID NO:5 is the sequence of a forward primer for the C84A survivinmutant.

SEQ ID NO:6 is the sequence of a forward primer for the T34A survivinmutant.

SEQ ID NO:7 is the sequence of a forward primer for the T34A survivinmutant.

SEQ ID NO:8 is an insert sequence.

DETAILED DESCRIPTION OF THE INVENTION

An antigen presenting cell displaying a variant survivin polypeptide wasproduced through transfection of dendritic cells (DCs) with a doublemutant (T34A and C84A) full length survivin protein adenovirus constructand confirmed by Western blot. Co-culture of MM patient-derived DCs withCD4+CD25− peripheral T cells ex vivo resulted in a significant increasein both the frequency and absolute number of survivin-reactive CD4+ Tcells, with a fold expansion range of 0-270× and median of 42×.Additionally, T cells expanded with DCs presenting this variant survivinprotein were survivin specific by IFN-gamma ELISpot analysis whenre-stimulated with survivin peptide pools, producing approximately threetimes as many spots as an irrelevant peptide control.

The invention concerns variant survivin polypeptides, nucleic acidmolecules encoding them, and antigen presenting cells (APCs), andcompositions containing the foregoing, useful as vaccines for thetreatment of existing malignancies and preventing or delaying the onsetof malignancies, and for raising or inducing immune responses (e.g., asurvivin-reactive CD4+ T cell response) in human or non-human animalsubjects. Accordingly, an aspect of the invention is directed to an APCcomprising a variant survivin polypeptide or a nucleic acid sequenceencoding the variant survivin polypeptide, wherein the variant survivinpolypeptide comprises at least consecutive amino acids 16-87 (N-terminalzinc-binding baculovirus inhibitor of apoptosis protein repeat (BIR)domain) of the human wild-type survivin polypeptide (SEQ ID NO:1)modified to have an amino acid at position 34 which is other thanthreonine and an amino acid at position 84 which is other than cysteine,relative to the human wild-type survivin polypeptide, and wherein thevariant survivin polypeptide:

(a) comprises a 142-amino acid sequence having at least 80% sequenceidentity to the human wild-type survivin polypeptide (SEQ ID NO:1), or

(b) is a subsequence (fragment) of the human wild-type survivinpolypeptide (SEQ ID NO:1).

Preferably, the APC presents portions of the variant survivinpolypeptide on its surface.

In some embodiments, one or both of the amino acids at position 34 andat position 84 are nonpolar amino acids. In some embodiments, one orboth of the amino acids at position 34 and at position 84 are alanine.

In some embodiments, the variant survivin polypeptide comprises thefull-length human wild-type survivin polypeptide having an amino acid atposition 34 which is other than threonine, and an amino acid at position84 which is other than cysteine, as set forth as SEQ ID NO:2.

In some embodiments, the variant survivin polypeptide further includesat least consecutive amino acids 6-10, consecutive amino acids 89-97(linker region), and consecutive amino acids 97-141 (coiled coil domain)of the human wild-type survivin polypeptide (SEQ ID NO:1).

As used herein, the term “antigen presenting cell” (APC) refers toprofessional antigen presenting cells (APC), which are selected fromamong dendritic cells, macrophages, and B cells. In some embodiments,the antigen presenting cell is a dendritic cell. In some embodiments,the APC is a mammalian cell. In some embodiments, the APC is a humancell.

Another aspect of the invention concerns a composition comprising avariant survivin polypeptide of the invention, a nucleic acid moleculeencoding the polypeptide, or APCs of the invention (APCs comprising thevariant survivin polypeptide or encoding nucleic acid sequence); and apharmaceutically acceptable carrier. The composition may include furtheringredients, such as an adjuvant or other anti-cancer agents, such as achemotherapeutic or immunotherapeutic agent, or an antigen (e.g., atumor-associated antigen).

When used in any of the methods or composition of the invention, anadjuvant may be of any class such as alum salts and other mineraladjuvants, bacterial products or bacteria-derived adjuvants, tensoactiveagents (e.g., saponins), oil-in-water (o/w) and water-in-oil (w/o)emulsions, liposome adjuvants, cytokines (e.g., IL-2, GM-CSF, IL-12, andIFN-gamma), and alpha-galactosylceramide analogs. Nonlimiting examplesof adjuvants include Montanide emulsions, QS21, Freund's complete orincomplete adjuvant, aluminum phosphate, aluminum hydroxide, BacillusCalmette-Guerin (BCG), and alum. In one embodiment, the adjuvant is anagent that enhances the immune system's response against the variantsurvivin polypeptide. The adjuvant may be administered in the samecomposition as the variant survivin polypeptide, expression vector, orAPC, or in a composition separate from the variant survivin polypeptide,expression vector, or APC.

Another aspect of the invention concerns a method for treating amalignancy, comprising administering to a subject in need of treatmentan effective amount of antigen presenting cells of the invention. Insome embodiments, the malignancy is myeloma or other hematologicmalignancy.

The APCs may be autologous, homologous (allogeneic), or heterologous tothe subject (recipient) to which the APCs are to be administered. Thesubject may be a human or non-human animal. In some embodiments, thesubject is a human or non-human mammal.

Optionally, the method further comprises administering another treatmentto the subject before, during, or after administration of the APCs. Insome embodiments, one or more additional anti-cancer agents areadministered to the subject before, during, or after administration ofthe APCs. In some embodiments, a chemotherapeutic drug, immunomodulator,adjuvant, anemia drug (e.g., erythropoietin), radiation therapy, stemcell transplant, or a combination of two or more of the foregoing isadministered to the subject before, during, or after administration ofthe APCs.

In some embodiments, the method does not include administration of ananti-CD25 antibody. In some embodiments, the method does not includeadministration of a humanized IgG1 monoclonal antibody that bindsspecifically to the alpha subunit (p55 alpha, CD25, or Tac subunit) ofthe human high-affinity interleukin-2 (IL-2) receptor.

The APCs (and compositions comprising the APCs) may be administered tothe subject by any route, locally or systemically. In some embodiments,the APCs are administered by intradermal injection, such as at ananatomical site that drains to the axillary and/or inguinal lymph nodebasins of the subject. The APCs may be administered one or more times atregular or irregular intervals. In some embodiments, the APCs areadministered multiple times over a period of days.

In some embodiments, the method further comprises administering anadjuvant before, during, or after administration of the APCs to thesubject. If administered to the subject simultaneously with the APCs,the adjuvant may be in the same composition as the APCs, or in aseparation composition.

The methods of the invention may further include administration ofadditional treatments before, during, or after administration of theAPCs to the subject. Additional treatments may involve a treatment suchas radiation or administration of an agent such a small molecule orbiologic agent such as cells (autologous, allogeneic, or xenogeneic celltransplantation). Optionally, cells may be preserved (e.g.,cryopreserved) prior to administration.

In some embodiments, the method further comprises conductinghematopoietic cell transplantation (hematopoietic stem cells orprogenitor cells, e.g., from bone marrow, peripheral blood, or cordblood) on the subject. In some embodiments, the cell transplant is anautologous hematopoietic cell. In some embodiments, administration ofthe APCs straddles administration of the hematopoietic celltransplantation, i.e., administered before and after the hematopoieticcell transplantation. The method may further comprise conducting stemcell mobilization on the subject (e.g., with G-CSF) and collecting thehematopoietic cells from the subject prior to autologous hematopoieticcell transplantation. The method may further comprise, prior to saidadministering, collecting mononuclear cells from the subject forproduction of the antigen presenting cells to be administered to thesubject. Optionally, cells may be cryopreserved prior to administration.

In some embodiments, the method further comprises administering achemotherapeutic agent (e.g., melphalan) before, during, or after saidadministering of the APCs.

Another aspect of the invention concerns a method for producing antigenpresenting cells producing a variant survivin polypeptide, comprisingtransfecting antigen presenting cells or their precursors with anexpression construct comprising a nucleic acid sequence encoding avariant survivin polypeptide, wherein the variant survivin polypeptidecomprises at least consecutive amino acids 16-87 (N-terminalzinc-binding baculovirus inhibitor of apoptosis protein repeat (BIR)domain) of the human wild-type survivin polypeptide (SEQ ID NO:1)modified to have an amino acid at position 34 which is other thanthreonine and an amino acid at position 84 which is other than cysteine,relative to the human wild-type survivin polypeptide, and wherein thevariant survivin polypeptide:

(a) comprises a 142-amino acid sequence having at least 80% sequenceidentity to the human wild-type survivin polypeptide (SEQ ID NO:1), or

(b) is a subsequence (fragment) of the human wild-type survivinpolypeptide (SEQ ID NO:1).

In some embodiments, the expression construct is a viral vector,non-viral vector, or naked DNA. Examples of viral vectors that may beused include, but are not limited to, adenovirus, adeno-associatedvirus, poxvirus, lentivirus, alphavirus, herpesvirus, retrovirus, andvaccinia virus. Prior to transfection, mononuclear cells may be obtainfrom the subject (e.g., by apheresis) for production of myeloiddendritic cells. Optionally, mononuclear cells are cryopreserved. Themethod may include culturing the cells and collecting the resulting APCsprior to said transfecting. In some embodiments, the mononuclear cellsare cultured in chemically defined, serum-free hematopoietic cellmedium, GM-CSF, and IL-4; and collecting the resulting antigenpresenting cells said transfecting.

Methods for making double mutant survivin constructs such as TC34,84AAhave been described and can be used to produce APCs of the invention(see, for example, Zhang et al., “A survivin double point mutant haspotent inhibitory effect on the growth of hepatocellular cancer cells”,Cancer Biology & Therapy, April 2008, 7(4):547-554, and Cheung et al.“Survivin—biology and potential as a therapeutic target in oncology”,OncoTargets and Therapy, 2013, 6:1453-1462, which are incorporatedherein by reference in their entirety).

For example, the following materials and methods can be utilized:1. Cloning of T34A/C84A survivin mutant:Template; pcDNA3.0-WT-SURVIVIN (CLONING SITE; EcoRI site)Mutation was established by QuikChange Site-Directed Mutagenesis kit(STRATAGENE); mutation primers are as follows;

Primer for C84A mutant: (SEQ ID NO: 4)5-CATAAAAAGCATTCGTCCGGTGCCGCTTTCCTTTCTGTCAAGAAG-3 (SEQ ID NO: 5)5-CTTCTTGACAGAAAGGAAAGCGGCACCGGACGAATGCTTTTTATG-3Primer for T34A mutant: (SEQ ID NO: 6)5-GAGGGCTGCGCCTGCGCCCCGGAGCGGATGGCC-3 (SEQ ID NO: 7)5-GGCCATCCGCTCCGGGGCGCAGGCGCAGCCCTC-3

2. Establishment of Shuttle Vector:

Subcloning Hind III/XbaI fragment of pcDNA3.0 T34A/C84A survivin mutantinto Hind III/XbaI site of pShuttle-CMV (7462 bp) for non GFP svv mutantor pAdTrack-CMV (9220 bp) for GFP svv mutant.

Insert sequence:

(SEQ ID NO: 8) AAGCTTGGTACCGAGCTCGGATCCACTAGTAACGGCCGCCAGTGTGCTGGAATTCATCTGTCGACTGCTACCGCCAGATTTGAATCGCGGGACCCGTTGGCAGAGGTGGCGGCGGCGGCATGGGTGCCCCGACGTTGCCCCCTGCCTGGCAGCCCTTTCTCAAGGACCACCGCATCTCTACATTCAAGAACTGGCCCTTCTTGGAGGGCTGCGCCTGCGCCCCGGAGCGGATGGCCGAGGCTGGCTTCATCCACTGCCCCACTGAGAACGAGCCAGACTTGGCCCAGTGTTTCTTCTGCTTCAAGGAGCTGGAAGGCTGGGAGCCAGATGACGACCCCATAGAGGAACATAAAAAGCATTCGTCCGGTGCCGCTTTCCTTTCTGTCAAGAAGCAGTTTGAAGAATTAACCCTTGGTGAATTTTTGAAACTGGACAGAGAAAGAGCCAAGAACAAAATTGCAAAGGAAACCAACAATAAGAAGAAAGAATTTGAGGAAACTGCGAAGAAAGTGCGCCGTGCCATCGAGCAGCTGGCTGCCATGGATTGAGGCCTCTGGCCGGAGCTGCCTGGTCCCAGAGTGGCTGCACCACTTCCAGGGTTTATTCCCTGGTGCCACCAGCCTTCCTGTGGGCCCCTTAGCAATGTCTTAGGAAAGGAGATCAACATTTTCAAATTAGATGTTTCAACTGTGCTCTTGTTTTGTCTTGAAAGTGGCACCAGAGGTGCTTCTGCCTGTGCAGCGGGTGCTGCTGGTAACAGTGGCTGCTTCTCTCTCTCTCTCTCTTTTTTGGGGGCTCATTTTTGCTGTTTTGATTCCCGGGGGATCCTAACATCGATAAAATAAAAGATTTTATTTAGTCTCCAGAAAAAGGGGGGAATGAAAGACCCCACCTGTAGGTTTGGCAAGCTAGCTTAAGTAACGCCATTTTGCAAGGCATGGAAAAATACATAACTGAGAATAGAGAAGTTCAGATCAAGGTCAGGAACAGATGGAACAGCTGAATATGGGCCAAACAGGATATCTGTGGTAAGCAGTTCCTGCCCCGGCTCAGGCCAAGAACAGATGGAACAGCTGAATATGGGCCAAACAGGATATCTGTGGTAAGCAGTTCCTGCCCCGGCTCAGGCCAAGAACAGATGGTCCCAGATTGCGGTCCAGCCCTCAGCAGTTTCTAAGATAGATATCCGA3. Homologous Recombination with Adenovirus Backbone Construct:Homologous recombination was done between pShuttle-CMV—svv mutant orpAdTrack-CMV-svv mutant and pAdEasy-2(30767 bp) in BJ5183 cell (E.coli).

In order to better understand the survivin-specific immune response andidentify vaccination strategies against myeloma and other cancers, thepresent inventors sought to characterize the survivin specific CD4+ Tcell response using survivin-derived peptide pools.

In healthy donors and myeloma patients the present inventors havequantified the peripheral blood CD4+ T cell precursor frequency reactiveagainst survivin (26). Survivin expression in myeloma patients' tumorscorrelates with decreased survivin-reactive CD4+ T cells. A full-lengthmutant survivin protein vaccine induces CD4+ responses independent ofthe survivin specific CD4+ precursor frequency. The inventors' resultshave several important implications.

Healthy donors have detectable T cells responsive against survivin whichdo not require in vitro expansion or cloning techniques to quantify.Prior reports employed methodology including multiple priming andstimulation steps to grow out clonal cells against survivin orvaccination to promote expansion in vivo. The presence ofsurvivin-reactive T cells in healthy donors is not entirely surprisingsince survivin protein expression is limited in adult tissues.

Myeloma patients have decreased survivin specific CD4+ cells compared tohealthy donors. The expression of tumor survivin inversely correlates tothe magnitude of the survivin-specific T cell precursor frequency.Clearly, these T cells are unsuccessful at mediating spontaneous tumorrejection in these myeloma patients. It may be inferred that this is dueto suppression or deletion of survivin-responsive T cells. Mechanismsfor evasion of a survivin specific immune response are yet to bedetermined; however, candidates include the active suppression byregulatory T cells (Tregs) or myeloid derived suppressor cells (MDSC),tumor microenvironment cell adhesion-mediated immune resistance (27), oranergy of survivin-specific T cells due to insufficient antigenpresentation (28).

Myeloma patients harbor tumor-specific Tregs which blunt T effectorresponses against myeloma (29), however Treg function may be impaired(30). Peripheral blood Tregs expand as myeloma progresses (31), althoughbone marrow Tregs are decreased compared to healthy controls (32).Considering these conflicting results, investigation into the precursorfrequency of survivin specific Tregs is warranted. Myeloma patient MDSCscan both suppress T cell activity and promote tumor growth, while themyeloma cells themselves may promote MDSC generation (33).Granulocytic-MDSC increase with myeloma progression (34) and MDSC areincreased in peripheral blood and bone marrow compared with healthycontrols (33). An in vivo model of immunogenic myeloma suggested MDSCinvolvement at early stages of myeloma progression, since there was aCD8+ dependent reduction in tumor growth when MDSC were excluded fromaccumulating in the bone marrow (35). Additional efforts should be takento quantify Treg and MDSC suppression of anti-myeloma T cells at thelevel of the microenvironment.

The interplay between myeloma cells and the bone marrow niche provides atumor survival advantage via multiple cytokines, growth factors, andcell adhesion-mediated drug resistance (36). Multiple factors such asIL-6, IDO, IL-17, TGF-beta, or VEGF may also act within the tumorenvironment to alter immune responses (37-39). Recent evidence suggeststhat marrow stromal cells can induce inhibitory PD-L1 expression onmyeloma cells (40) and protect myeloma cells from T cell cytotoxicity(27). Multiple mechanisms control peripheral tolerance, however directinduction of lymphocyte tolerance is termed anergy (41). Classicalclonal anergy results from the insufficient delivery of cognate antigenor co-stimulatory signals to the T cell which directly results indysfunction (42). In myeloma patients chronic antigen exposure (43),tumor up-regulation of PD-L1 (40), or T cell expression of PD-1 (44) andCTLA-4 (45) may all play a role in T cell dysfunction against survivinor other tumor associated antigens. Additional study of the relationshipbetween marrow stroma, microenvironmental factors, T cell inhibitorysignals and the spontaneous anti-tumor T cell response against myelomais needed.

The use of a full-length mutant survivin vaccine allows expansion ofsurvivin-specific CD4+ T cells regardless of the precursor frequency ofthe reactive CD4+ survivin cells. The survivin protein vaccine utilizesDCs transduced with an adenoviral construct containing a full-lengthmutant survivin (46). This vaccine elicits a survivin-specific immuneresponse when used in vitro to stimulate cells from healthy donors andprostate cancer patients (47). In murine models, this vaccine generatesa potent multi-epitope survivin-specific response and mediates both invitro and in vivo antitumor immunity (25). A full-length protein vaccineis desirable for several reasons. It does not require HLA typing,thereby maximizing patient eligibility. Presentation of multipleantigens will maximize immunogenicity and CD4+ and CD8+ immune responsesshould be allowable. The inventors have demonstrated herein that thevaccine is able to expand CD4+ T cells reactive against survivin.Importantly, this is possible regardless of the precursor frequency ofsurvivin-reactive T cells. This implies that the vaccine may inducesurvivin specific CD4+ immune responses even when the survivin specificCD4+ T cell precursor frequency is below the level of detection of thecurrent assay. In summary, accurate methodology and understanding of theCD4+ T cell response against survivin is necessary for the developmentof cancer immunotherapies against survivin-expressing tumors. Theinventors have, for the first time, quantified the circulating, CD4+precursor frequency against survivin in healthy donors and myelomapatients. This response is lower in myeloma patients compared to healthydonors, and inversely correlates to tumor survivin expression. The useof a full-length mutant survivin vaccine expands survivin-reactive CD4+cells independent of the survivin-reactive CD4+ precursor frequency.

Mammalian species which benefit from the disclosed compositions andmethods include, but are not limited to, primates, such as apes,chimpanzees, orangutans, humans, monkeys; domesticated animals (e.g.,pets) such as dogs, cats, guinea pigs, hamsters, Vietnamese pot-belliedpigs, rabbits, and ferrets; domesticated farm animals such as cows,buffalo, bison, horses, donkey, swine, sheep, and goats; exotic animalstypically found in zoos, such as bear, lions, tigers, panthers,elephants, hippopotamus, rhinoceros, giraffes, antelopes, sloth,gazelles, zebras, wildebeests, prairie dogs, koala bears, kangaroo,opossums, raccoons, pandas, hyena, seals, sea lions, elephant seals,otters, porpoises, dolphins, and whales. Other species that may benefitfrom the disclosed methods include fish, amphibians, avians, andreptiles. As used herein, the terms “patient”, “subject”, and“individual” are used interchangeably and are intended to include suchhuman and non-human species unless specified to be human or non-human.

Subjects in need of treatment using the methods of the present invention(e.g., having a malignancy) can be identified using standard techniquesknown to those in the medical or veterinary professions, as appropriate.A subject having a malignancy may be symptomatic or asymptomatic.

Patient responsiveness to treatment for a particular disorder can bebased on a measurable parameter that is indicative of patientimprovement after receiving a therapeutic treatment.

The terms “cancer” and “malignancy” are used herein interchangeably torefer to or describe the physiological condition in mammals that istypically characterized by unregulated cell growth. The cancer may bedrug-resistant or drug-sensitive. The cancer may be primary ormetastatic. The cancer may represent early, middle, or late stagedisease, and be acute or chronic. Preferably, the cancer is one thatexpresses survivin at an abnormal or aberrantly high level relative tothe corresponding normal cell or tissue type (see, for example, thosecancers identified in Fukuda S and L M Pelus, Mol Cancer Ther, 2006,5(5):1087-1098; and Pennati M et al., Carcinogenesis, 2007,28(6):1133-1139, which are each incorporated herein by reference intheir entirety). Examples of cancers that over-express survivin includebut are not limited to esophageal, lung, central nervous system, breast,colorectal, bladder, gastric, prostate, pancreatic, laryngeal, uterine,hepatocellular, renal, melanoma, soft tissue sarcoma, and hematologicmalignancies such as lymphoma, acute leukemia, or myelodysplasticsyndrome (MDS).

Examples of cancer include but are not limited to, carcinoma, lymphoma,blastoma, sarcoma, and leukemia. More particular examples of suchcancers include breast cancer, prostate cancer, colon cancer, squamouscell cancer, small-cell lung cancer, non-small cell lung cancer,gastrointestinal cancer, pancreatic cancer, cervical cancer, ovariancancer, peritoneal cancer, liver cancer, e.g., hepatic carcinoma,bladder cancer, colorectal cancer, endometrial carcinoma, kidney cancer,and thyroid cancer. In some embodiments, the cancer is melanoma, MDS,ovarian cancer, breast cancer, or multiple myeloma.

In some embodiments, the cancer is liver cancer. In other embodiments,the cancer is a cancer other than liver cancer.

Other non-limiting examples of cancers are basal cell carcinoma, biliarytract cancer; bone cancer; brain and CNS cancer; choriocarcinoma;connective tissue cancer; esophageal cancer; eye cancer; cancer of thehead and neck; gastric cancer; intra-epithelial neoplasm; larynx cancer;lymphoma including Hodgkin's and Non-Hodgkin's lymphoma; melanoma;myeloma; neuroblastoma; oral cavity cancer (e.g., lip, tongue, mouth,and pharynx); retinoblastoma; rhabdomyosarcoma; rectal cancer; cancer ofthe respiratory system; sarcoma; skin cancer; stomach cancer; testicularcancer; uterine cancer; cancer of the urinary system, as well as othercarcinomas and sarcomas. Examples of cancer types that may be treatedwith the compositions and methods of the invention are listed in Table1.

TABLE 1 Examples of Cancer Types Acute Lymphoblastic Leukemia, AdultHairy Cell Leukemia Acute Lymphoblastic Leukemia, Head and Neck CancerChildhood Hepatocellular (Liver) Cancer, Adult (Primary) Acute MyeloidLeukemia, Adult Hepatocellular (Liver) Cancer, Childhood Acute MyeloidLeukemia, Childhood (Primary) Adrenocortical Carcinoma Hodgkin'sLymphoma, Adult Adrenocortical Carcinoma, Childhood Hodgkin's Lymphoma,Childhood AIDS-Related Cancers Hodgkin's Lymphoma During PregnancyAIDS-Related Lymphoma Hypopharyngeal Cancer Anal Cancer Hypothalamic andVisual Pathway Glioma, Astrocytoma, Childhood Cerebellar ChildhoodAstrocytoma, Childhood Cerebral Intraocular Melanoma Basal CellCarcinoma Islet Cell Carcinoma (Endocrine Pancreas) Bile Duct Cancer,Extrahepatic Kaposi's Sarcoma Bladder Cancer Kidney (Renal Cell) CancerBladder Cancer, Childhood Kidney Cancer, Childhood Bone Cancer,Osteosarcoma/Malignant Laryngeal Cancer Fibrous Histiocytoma LaryngealCancer, Childhood Brain Stem Glioma, Childhood Leukemia, AcuteLymphoblastic, Adult Brain Tumor, Adult Leukemia, Acute Lymphoblastic,Childhood Brain Tumor, Brain Stem Glioma, Leukemia, Acute Myeloid, AdultChildhood Leukemia, Acute Myeloid, Childhood Brain Tumor, CerebellarAstrocytoma, Leukemia, Chronic Lymphocytic Childhood Leukemia, ChronicMyelogenous Brain Tumor, Cerebral Leukemia, Hairy CellAstrocytoma/Malignant Glioma, Lip and Oral Cavity Cancer Childhood LiverCancer, Adult (Primary) Brain Tumor, Ependymoma, Childhood Liver Cancer,Childhood (Primary) Brain Tumor, Medulloblastoma, Lung Cancer, Non-SmallCell Childhood Lung Cancer, Small Cell Brain Tumor, SupratentorialPrimitive Lymphoma, AIDS-Related Neuroectodermal Tumors, ChildhoodLymphoma, Burkitt's Brain Tumor, Visual Pathway and Lymphoma, CutaneousT-Cell, see Mycosis Hypothalamic Glioma, Childhood Fungoides and SézarySyndrome Brain Tumor, Childhood Lymphoma, Hodgkin's, Adult Breast CancerLymphoma, Hodgkin's, Childhood Breast Cancer, Childhood Lymphoma,Hodgkin's During Pregnancy Breast Cancer, Male Lymphoma, Non-Hodgkin's,Adult Bronchial Adenomas/Carcinoids, Lymphoma, Non-Hodgkin's, ChildhoodChildhood Lymphoma, Non-Hodgkin's During Pregnancy Burkitt's LymphomaLymphoma, Primary Central Nervous System Carcinoid Tumor, ChildhoodMacroglobulinemia, Waldenström's Carcinoid Tumor, GastrointestinalMalignant Fibrous Histiocytoma of Carcinoma of Unknown PrimaryBone/Osteosarcoma Central Nervous System Lymphoma, Medulloblastoma,Childhood Primary Melanoma Cerebellar Astrocytoma, Childhood Melanoma,Intraocular (Eye) Cerebral Astrocytoma/Malignant Glioma, Merkel CellCarcinoma Childhood Mesothelioma, Adult Malignant Cervical CancerMesothelioma, Childhood Childhood Cancers Metastatic Squamous NeckCancer with Occult Chronic Lymphocytic Leukemia Primary ChronicMyelogenous Leukemia Multiple Endocrine Neoplasia Syndrome, ChronicMyeloproliferative Disorders Childhood Colon Cancer MultipleMyeloma/Plasma Cell Neoplasm Colorectal Cancer, Childhood MycosisFungoides Cutaneous T-Cell Lymphoma, see Myelodysplastic SyndromesMycosis Fungoides and Sézary Myelodysplastic/Myeloproliferative DiseasesSyndrome Myelogenous Leukemia, Chronic Endometrial Cancer MyeloidLeukemia, Adult Acute Ependymoma, Childhood Myeloid Leukemia, ChildhoodAcute Esophageal Cancer Myeloma, Multiple Esophageal Cancer, ChildhoodMyeloproliferative Disorders, Chronic Ewing's Family of Tumors NasalCavity and Paranasal Sinus Cancer Extracranial Germ Cell Tumor,Nasopharyngeal Cancer Childhood Nasopharyngeal Cancer, ChildhoodExtragonadal Germ Cell Tumor Neuroblastoma Extrahepatic Bile Duct CancerNon-Hodgkin's Lymphoma, Adult Eye Cancer, Intraocular MelanomaNon-Hodgkin's Lymphoma, Childhood Eye Cancer, RetinoblastomaNon-Hodgkin's Lymphoma During Pregnancy Gallbladder Cancer Non-SmallCell Lung Cancer Gastric (Stomach) Cancer Oral Cancer, Childhood Gastric(Stomach) Cancer, Childhood Oral Cavity Cancer, Lip and GastrointestinalCarcinoid Tumor Oropharyngeal Cancer Germ Cell Tumor, Extracranial,Osteosarcoma/Malignant Fibrous Histiocytoma Childhood of Bone Germ CellTumor, Extragonadal Ovarian Cancer, Childhood Germ Cell Tumor, OvarianOvarian Epithelial Cancer Gestational Trophoblastic Tumor Ovarian GermCell Tumor Glioma, Adult Ovarian Low Malignant Potential Tumor Glioma,Childhood Brain Stem Pancreatic Cancer Glioma, Childhood CerebralPancreatic Cancer, Childhood Astrocytoma Pancreatic Cancer, Islet CellGlioma, Childhood Visual Pathway and Paranasal Sinus and Nasal CavityCancer Hypothalamic Parathyroid Cancer Skin Cancer (Melanoma) PenileCancer Skin Carcinoma, Merkel Cell Pheochromocytoma Small Cell LungCancer Pineoblastoma and Supratentorial Primitive Small Intestine CancerNeuroectodermal Tumors, Childhood Soft Tissue Sarcoma, Adult PituitaryTumor Soft Tissue Sarcoma, Childhood Plasma Cell Neoplasm/MultipleMyeloma Squamous Cell Carcinoma, see Skin Pleuropulmonary BlastomaCancer (non-Melanoma) Pregnancy and Breast Cancer Squamous Neck Cancerwith Occult Pregnancy and Hodgkin's Lymphoma Primary, MetastaticPregnancy and Non-Hodgkin's Lymphoma Stomach (Gastric) Cancer PrimaryCentral Nervous System Lymphoma Stomach (Gastric) Cancer, ChildhoodProstate Cancer Supratentorial Primitive Rectal Cancer NeuroectodermalTumors, Childhood Renal Cell (Kidney) Cancer T-Cell Lymphoma, Cutaneous,see Renal Cell (Kidney) Cancer, Childhood Mycosis Fungoides and SézaryRenal Pelvis and Ureter, Transitional Cell Syndrome Cancer TesticularCancer Retinoblastoma Thymoma, Childhood Rhabdomyosarcoma, ChildhoodThymoma and Thymic Carcinoma Salivary Gland Cancer Thyroid CancerSalivary Gland Cancer, Childhood Thyroid Cancer, Childhood Sarcoma,Ewing's Family of Tumors Transitional Cell Cancer of the Renal Sarcoma,Kaposi's Pelvis and Ureter Sarcoma, Soft Tissue, Adult TrophoblasticTumor, Gestational Sarcoma, Soft Tissue, Childhood Unknown Primary Site,Carcinoma of, Sarcoma, Uterine Adult Sezary Syndrome Unknown PrimarySite, Cancer of, Skin Cancer (non-Melanoma) Childhood Skin Cancer,Childhood Unusual Cancers of Childhood Ureter and Renal Pelvis,Transitional Cell Cancer Urethral Cancer Uterine Cancer, EndometrialUterine Sarcoma Vaginal Cancer Visual Pathway and Hypothalamic Glioma,Childhood Vulvar Cancer Waldenström's Macroglobulinemia Wilms' Tumor

In some embodiments, the malignancy is a myeloma. The myeloma may bestage I, stage II, or stage III based on Durie-Salmon staging, and/orGroup A or Group B based on kidney function. For example, a subjectcould be classified as Stage IIB. Another staging system that may beutilized is the International Staging system (ISS), which is based onthe albumin level (more or less than 3.5 mg/dL) and B2-microglobulinlevel (<3.5; 3.5-5 or >5 mg/L). The myeloma may be of any ISS stage,and/or of various types such as monoclonal gammopathy of undeterminedsignificance (MGUS), asymptomatic (smoldering/indolent), or symptomatic(active) myeloma.

In some embodiments, the malignancy is one that overexpresses survivin.

As used herein, the term “tumor” refers to all neoplastic cell growthand proliferation, whether malignant or benign, and all pre-cancerousand cancerous cells and tissues. For example, a particular cancer may becharacterized by a solid mass tumor or non-solid tumor. The solid tumormass, if present, may be a primary tumor mass. A primary tumor massrefers to a growth of cancer cells in a tissue resulting from thetransformation of a normal cell of that tissue. In most cases, theprimary tumor mass is identified by the presence of a cyst, which can befound through visual or palpation methods, or by irregularity in shape,texture or weight of the tissue. However, some primary tumors are notpalpable and can be detected only through medical imaging techniquessuch as X-rays (e.g., mammography) or magnetic resonance imaging (MRI),or by needle aspirations. The use of these latter techniques is morecommon in early detection. Molecular and phenotypic analysis of cancercells within a tissue can usually be used to confirm if the cancer isendogenous to the tissue or if the lesion is due to metastasis fromanother site. Some tumors are unresectable (cannot be surgically removeddue to, for example the number of metastatic foci or because it is in asurgical danger zone). The treatment and prognostic methods of theinvention can be utilized for early, middle, or late stage disease, andacute or chronic disease.

Compositions and Treatments

Various methods may be used to deliver the variant survivin polypeptide,or deliver a nucleic acid sequence encoding the variant polypeptide, inorder to produce an antigen presenting cell (APC), such as a dendriticcell, of the invention. Preferably, the APC presents portions of thevariant survivin polypeptide on its self surface.

Examples of methods that may be utilized to deliver the variant survivinpolypeptide or encoding nucleic acid molecules to produce the APCs ofthe invention include, but are not limited to, viral vectors, such asretro virus, adenovirus, adeno-associated virus, lentivirus, vesicularstomatitis virus, or herpes simplex virus; nanoparticles; naked orpacked protein; peptide pools of variant survivin polypeptides; geneediting systems such as TALEN (Transcription Activator-Like EffectorNucleases) or CRISPR (Clustered Regulatory Interspaced Short PalindromicRepeats)/Cas9 systems (see, for example, Nemudryi A A et al., ActaNature, 2014 July-September, 6(3):19-40, which is incorporated herein byreference); DNA (naked or packaged); mRNA (naked or packaged);electroporation; sonoporation; gene gun, gold or other metal particles;magnetofication; hydrodynamic delivery; DNA plasmid; siiRNA,oligonucleotides, lipoplexes; lipoproteins, homing nucleases;polymersomes; polyplexes; transposon (e.g., sleeping beauty transposon,see for example, Ivies Z et al., Hum Gene Ther 2011, 22(9):1043-1051,which is incorporated herein by reference in its entirety); dendrimer;macromolecule; inorganic nanoparticle; quantum dot, cell penetratingpeptide (also known as a peptide transduction domain) such as HIV TATprotein, Antennapedia transduction domain, transportan, or polyarginine(see, for example, Copolovici D M et al., ACS Nano, 2014,8(3):1972-1994; Wagstaff K M et al., Curr Meth Chem, 2006,13(12):1371-87, and Trabulo S et al., Pharmaceuticals, 2010, 3:961-993,which are incorporated herein by reference in their entirety); virosome;hybridizing virus; bacteriophage; or gene targeting.

Methods for making dendritic cell vaccines with other tumor antigens andtheir use for cancer immunotherapy are known and may be used with thevariant survivin molecules described herein (see, for example, Palucka Ket al., Nature Reviews Cancer, 2012, 12:265-277, which is incorporatedherein by reference in its entirety).

Viral or non-viral gene delivery methods may be used to transfect cellssuch as APCs with nucleic acids encoding the variant survivinpolypeptide.

Examples of viral vectors that may be used to deliver nucleic acidsinclude but are not limited to adenovirus (AV), adeno-associated virus(AAV), poxvirus, lentivrus, alphavirus, herpesvirus, retrovirus, andvaccinia virus.

Non-viral methods for gene delivery include, but are not limited to,naked DNA injection, inorganic particles, synthetic or naturalbiodegradable particles, as well as physical methods such as needleinjection, ballistic DNA injection, electroporation, sonoporation,photoporation, magnetofectoin, and hydroporation. Examples of inorganicparticles include calcium phosphate, silica, gold, and magneticparticles. Examples of synthetic or natural biodegradable particlesinclude polymeric-based non-viral vectors such aspoly(lactic-co-glycolic acid (PLGA), poly lactic acid (PLA),poly(ethylene imine4) (PEI), chitosan, dendrimers, andpolymethacrylates; cationic lipid-based non-viral vectors such ascationic liposomes, cationic emulsions, and solid lipid nanoparticles;and peptide-based non-viral vectors such as poly-L-lysine.

Optionally, APCs such as dendritic cells comprising a variant survivinpolypeptide (presenting portions of the variant survivin polypeptide)can be co-administered, simultaneously or consecutively, with one ormore other agents to a subject. Anti-cancer agents that may beadministered include but are not limited to those listed Table 2.

Co-administration can be carried out simultaneously (in the same orseparate formulations) or consecutively with the additional agentadministered before and/or after one or more compounds disclosed herein.

Thus, the APCs, whether administered separately, or as a pharmaceuticalcomposition, can include various other components. Examples ofacceptable components or adjuncts which can be employed in relevantcircumstances include antioxidants, free radical scavenging agents,peptides, growth factors, antibiotics, bacteriostatic agents,immunosuppressives, anticoagulants, buffering agents, anti-inflammatoryagents, anti-angiogenics, anti-pyretics, time-release binders,anesthetics, steroids, and corticosteroids. Such components can provideadditional therapeutic benefit, act to affect the therapeutic action ofthe APCs and variant survivin polypeptide, or act towards preventing anypotential side effects which may be posed as a result of administrationof the compounds.

Additional agents that can be co-administered to target cells in vitroor in vivo, such as in a subject, in the same or as a separateformulation, include those that modify a given biological response, suchas immunomodulators. The additional agents may be, for example, smallmolecules, polypeptides (proteins, peptides, or antibodies or antibodyfragments), or nucleic acids (encoding polypeptides or inhibitorynucleic acids such as antisense oligonucleotides or interfering RNA).For example, proteins such as tumor necrosis factor (TNF), interferon(such as alpha-interferon and beta-interferon), nerve growth factor(NGF), platelet derived growth factor (PDGF), and tissue plasminogenactivator can be administered. Biological response modifiers, such aslymphokines, interleukins (such as interleukin-1 (IL-1), interleukin-2(IL-2), and interleukin-6 (IL-6)), granulocyte macrophage colonystimulating factor (GM-CSF), granulocyte colony stimulating factor(G-CSF), or other growth factors can be administered. In one embodiment,the methods and compositions of the invention incorporate one or moreanti-cancer agents, such as cytotoxic agents, chemotherapeutic agents,anti-signaling agents, and anti-angiogenic agents.

In some embodiments, the compositions of the invention include at leastone additional anti-cancer agent (e.g., a chemotherapeutic agent). Insome embodiments of the methods of the invention, at least oneadditional anti-cancer agent is administered with the compound of theinvention. In some embodiments, the anti-cancer agent is selected fromamong suberoylanilide hydroxamic acid (SAHA) or other histonedeacetylase inhibitor, arsenic trioxide, doxorubicin or otheranthracycline DNA intercalating agent, and etoposide or othertopoisomerase II inhibitor.

In some embodiments, the compositions can include, and the methods caninclude administration of, one or more proteasome inhibitors (e.g.,bortezomib), inhibitors of autophagy (e.g., chloroquine), alkylatingagents (e.g., melphalan, cyclophosphamide), MEK inhibitors (e.g.,PD98509), FAK/PYK2 inhibitors (e.g., PF562271), or EGFR inhibitors(e.g., erlotinib, gefitinib, cetuximab, panitumumab, zalutumumab,nimotuzumab, matuzumab), or a combination of two or more of theforegoing.

Thus, immunotherapeutics, whether administered separately, or as apharmaceutical composition, can include various other components asadditives. Examples of acceptable components or adjuncts which can beemployed in relevant circumstances include antioxidants, free radicalscavenging agents, peptides, growth factors, antibiotics, bacteriostaticagents, immunosuppressives, anticoagulants, buffering agents,anti-inflammatory agents, anti-angiogenics, anti-pyretics, time-releasebinders, anesthetics, steroids, and corticosteroids. Such components canprovide additional therapeutic benefit, act to affect the therapeuticaction of the compounds of the invention, or act towards preventing anypotential side effects which may be posed as a result of administrationof the compounds. The immunotherapeutic agent can be conjugated to atherapeutic agent or other agent, as well.

As used herein, the term “immunotherapy” refers to the treatment ofdisease via the stimulation, induction, subversion, mimicry,enhancement, augmentation or any other modulation of a subject's immunesystem to elicit or amplify adaptive or innate immunity (actively orpassively) against cancerous or otherwise harmful proteins, cells ortissues. Immunotherapies (i.e., immunotherapeutic agents) include cancervaccines, immunomodulators, monoclonal antibodies (e.g., humanizedmonoclonal antibodies), immunostimulants, dendritic cells, and viraltherapies, whether designed to treat existing cancers or prevent thedevelopment of cancers or for use in the adjuvant setting to reducelikelihood of recurrence of cancer. Examples of cancer vaccines includeGVAX, Stimuvax, DCVax and other vaccines designed to elicit immuneresponses to tumor and other antigens including MUC1, NY-ESO-1, MAGE,p53 and others. Examples of immunomodulators include 1MT, Ipilimumab,Tremelimumab and/or any drug designed to de-repress or otherwisemodulate cytotoxic or other T cell activity against tumor or otherantigens, including, but not restricted to, treatments that modulateT-Reg cell control pathways via CTLA-4, CD80, CD86, MHC, B7-DC, B7-H1,B7-H2, B7-H3, B7-H4, CD28, other TCRs, PD-1, PDL-1, CD80, ICOS and theirligands, whether via blockade, agonist or antagonist. Examples ofimmunostimulants include corticosteroids and any other anti- orpro-inflammatory agent, steroidal or non-steroidal, including, but notrestricted to, GM-CSF, interleukins (e.g., IL-2, IL-7, IL-12), cytokinessuch as the interferons, and others. Examples of dendritic cell (DC)therapies include modified dendritic cells and any other antigenpresenting cell, autologous or xeno, whether modified by multipleantigens, whole cancer cells, single antigens, by mRNA, phage display orany other modification, including but not restricted to exvivo-generated, antigen-loaded dendritic cells (DCs) to induceantigen-specific T-cell immunity, ex vivo gene-loaded DCs to inducehumoral immunity, ex vivo-generated antigen-loaded DCs inducetumour-specific immunity, ex vivo-generated immature DCs to inducetolerance, including but not limited to Provenge and others. Examples ofviral therapies include oncolytic viruses or virus-derived genetic orother material designed to elicit anti-tumor immunity and inhibitors ofinfectious viruses associated with tumor development, such as drugs inthe Prophage series. Examples of monoclonal antibodies includeAlemtuzumab, Bevacizumab, Cetuximab, Gemtuzumab ozogamicin, Rituximab,Trastuzumab, Radioimmunotherapy, Ibritumomab tiuxetan,Tositumomab/iodine tositumomab regimen. An immunotherapy may be amonotherapy or used in combination with one or more other therapies (oneor more other immunotherapies or non-immunotherapies).

As used herein, the term “cytotoxic agent” refers to a substance thatinhibits or prevents the function of cells and/or causes destruction ofcells in vitro and/or in vivo. The term is intended to includeradioactive isotopes (e.g., At²¹¹, I¹³¹, I¹²⁵, Y⁹⁰, Re¹⁸⁶, Re¹⁸⁸, Sm¹⁵³,Bi²¹², P³², and radioactive isotopes of Lu), chemotherapeutic agents,toxins such as small molecule toxins or enzymatically active toxins ofbacterial, fungal, plant or animal origin, and antibodies, includingfragments and/or variants thereof.

As used herein, the term “chemotherapeutic agent” is a chemical compounduseful in the treatment of cancer, such as, for example, taxanes, e.g.,paclitaxel (TAXOL, BRISTOL-MYERS SQUIBB Oncology, Princeton, N.J.) anddoxetaxel (TAXOTERE, Rhone-Poulenc Rorer, Antony, France), chlorambucil,vincristine, vinblastine, anti-estrogens including for exampletamoxifen, raloxifene, aromatase inhibiting 4(5)-imidazoles,4-hydroxytamoxifen, trioxifene, keoxifene, LY117018, onapristone, andtoremifene (FARESTON, GTx, Memphis, Tenn.), and anti-androgens such asflutamide, nilutamide, bicalutamide, leuprolide, and goserelin, etc.Examples of anti-cancer agents, including chemotherapeutic agents, thatmay be used in conjunction with the compounds of the invention arelisted in Table 2. In a preferred embodiment, the chemotherapeutic agentis one or more anthracyclines. Anthracyclines are a family ofchemotherapy drugs that are also antibiotics. The anthracyclines act toprevent cell division by disrupting the structure of the DNA andterminate its function by: (1) intercalating into the base pairs in theDNA minor grooves; and (2) causing free radical damage of the ribose inthe DNA. The anthracyclines are frequently used in leukemia therapy.Examples of anthracyclines include daunorubicin (CERUBIDINE),doxorubicin (ADRIAMYCIN, RUBEX), epirubicin (ELLENCE, PHARMORUBICIN),and idarubicin (IDAMYCIN).

TABLE 2 Examples of Anti-Cancer Agents 13-cis-Retinoic Acid Mylocel2-Amino-6- Letrozole Mercaptopurine Neosar 2-CdA Neulasta2-Chlorodeoxyadenosine Neumega 5-fluorouracil Neupogen 5-FU Nilandron6 - TG Nilutamide 6 - Thioguanine Nitrogen Mustard 6-MercaptopurineNovaldex 6-MP Novantrone Accutane Octreotide Actinomycin-D Octreotideacetate Adriamycin Oncospar Adrucil Oncovin Agrylin Ontak Ala-Cort OnxalAldesleukin Oprevelkin Alemtuzumab Orapred Alitretinoin OrasoneAlkaban-AQ Oxaliplatin Alkeran Paclitaxel All-transretinoic acidPamidronate Alpha interferon Panretin Altretamine ParaplatinAmethopterin Pediapred Amifostine PEG Interferon AminoglutethimidePegaspargase Anagrelide Pegfilgrastim Anandron PEG-INTRON AnastrozolePEG-L-asparaginase Arabinosylcytosine Phenylalanine Mustard Ara-CPlatinol Aranesp Platinol-AQ Aredia Prednisolone Arimidex PrednisoneAromasin Prelone Arsenic trioxide Procarbazine Asparaginase PROCRIT ATRAProleukin Avastin Prolifeprospan 20 with Carmustine implant BCGPurinethol BCNU Raloxifene Bevacizumab Rheumatrex Bexarotene RituxanBicalutamide Rituximab BiCNU Roveron-A (interferon alfa-2a) BlenoxaneRubex Bleomycin Rubidomycin hydrochloride Bortezomib SandostatinBusulfan Sandostatin LAR Busulfex Sargramostim C225 Solu-Cortef CalciumLeucovorin Solu-Medrol Campath STI-571 Camptosar StreptozocinCamptothecin-11 Tamoxifen Capecitabine Targretin Carac Taxol CarboplatinTaxotere Carmustine Temodar Carmustine wafer Temozolomide CasodexTeniposide CCNU TESPA CDDP Thalidomide CeeNU Thalomid CerubidineTheraCys cetuximab Thioguanine Chlorambucil Thioguanine TabloidCisplatin Thiophosphoamide Citrovorum Factor Thioplex CladribineThiotepa Cortisone TICE Cosmegen Toposar CPT-11 TopotecanCyclophosphamide Toremifene Cytadren Trastuzumab Cytarabine TretinoinCytarabine liposomal Trexall Cytosar-U Trisenox Cytoxan TSPA DacarbazineVCR Dactinomycin Velban Darbepoetin alfa Velcade Daunomycin VePesidDaunorubicin Vesanoid Daunorubicin Viadur hydrochloride VinblastineDaunorubicin liposomal Vinblastine Sulfate DaunoXome Vincasar PfsDecadron Vincristine Delta-Cortef Vinorelbine Deltasone Vinorelbinetartrate Denileukin diftitox VLB DepoCyt VP-16 Dexamethasone VumonDexamethasone acetate Xeloda dexamethasone sodium Zanosar phosphateZevalin Dexasone Zinecard Dexrazoxane Zoladex DHAD Zoledronic acid DICZometa Diodex Gliadel wafer Docetaxel Glivec Doxil GM-CSF DoxorubicinGoserelin Doxorubicin liposomal granulocyte - colony stimulating factorDroxia Granulocyte macrophage colony stimulating DTIC factor DTIC-DomeHalotestin Duralone Herceptin Efudex Hexadrol Eligard Hexalen EllenceHexamethylmelamine Eloxatin HMM Elspar Hycamtin Emcyt Hydrea EpirubicinHydrocort Acetate Epoetin alfa Hydrocortisone Erbitux Hydrocortisonesodium phosphate Erwinia L-asparaginase Hydrocortisone sodium succinateEstramustine Hydrocortone phosphate Ethyol Hydroxyurea EtopophosIbritumomab Etoposide Ibritumomab Tiuxetan Etoposide phosphate IdamycinEulexin Idarubicin Evista Ifex Exemestane IFN-alpha Fareston IfosfamideFaslodex IL - 2 Femara IL-11 Filgrastim Imatinib mesylate FloxuridineImidazole Carboxamide Fludara Interferon alfa Fludarabine InterferonAlfa-2b (PEG conjugate) Fluoroplex Interleukin - 2 FluorouracilInterleukin-11 Fluorouracil (cream) Intron A (interferon alfa-2b)Fluoxymesterone Leucovorin Flutamide Leukeran Folinic Acid Leukine FUDRLeuprolide Fulvestrant Leurocristine G-CSF Leustatin Gefitinib LiposomalAra-C Gemcitabine Liquid Pred Gemtuzumab ozogamicin Lomustine GemzarL-PAM Gleevec L-Sarcolysin Lupron Meticorten Lupron Depot MitomycinMatulane Mitomycin-C Maxidex Mitoxantrone Mechlorethamine M-PrednisolMechlorethamine MTC Hydrochlorine MTX Medralone Mustargen Medrol MustineMegace Mutamycin Megestrol Myleran Megestrol Acetate Iressa MelphalanIrinotecan Mercaptopurine Isotretinoin Mesna Kidrolase Mesnex LanacortMethotrexate L-asparaginase Methotrexate Sodium LCR Methylprednisolone

While APCs in the compositions and methods of the invention can beadministered to subjects as isolated agents, it is preferred toadminister these cells as part of a pharmaceutical composition. Thesubject invention thus further provides compositions comprising thedescribed APCs in association with at least one pharmaceuticallyacceptable carrier. The pharmaceutical composition can be adapted forvarious routes of administration, such as enteral, parenteral,intravenous, intramuscular, topical, subcutaneous, and so forth.Administration can be continuous or at distinct intervals, as can bedetermined by a person of ordinary skill in the art.

The compositions, variant survivin polypeptides, nucleic acid moleculesencoding variant survivin polypeptides, expression constructs, and APCsadministered in accordance with the methods of the invention can beformulated according to known methods for preparing pharmaceuticallyuseful compositions. Formulations are described in a number of sourceswhich are well known and readily available to those skilled in the art.For example, Remington's Pharmaceutical Science (Martin, E. W., 1995,Easton Pa., Mack Publishing Company, 19^(th) ed.) describes formulationswhich can be used in connection with the subject invention. Formulationssuitable for administration include, for example, aqueous sterileinjection solutions, which may contain antioxidants, buffers,bacteriostats, and solutes that render the formulation isotonic with theblood of the intended recipient; and aqueous and nonaqueous sterilesuspensions which may include suspending agents and thickening agents.The formulations may be presented in unit-dose or multi-dose containers,for example sealed ampoules and vials, and may be stored in a freezedried (lyophilized) condition requiring only the condition of thesterile liquid carrier, for example, water for injections, prior to use.Extemporaneous injection solutions and suspensions may be prepared fromsterile powder, granules, tablets, etc. It should be understood that inaddition to the ingredients particularly mentioned above, thecompositions of the subject invention can include other agentsconventional in the art having regard to the type of formulation inquestion.

Examples of pharmaceutically acceptable salts are organic acid additionsalts formed with acids that form a physiological acceptable anion, forexample, tosylate, methanesulfonate, acetate, citrate, malonate,tartarate, succinate, benzoate, ascorbate, alpha-ketoglutarate, andalpha-glycerophosphate. Suitable inorganic salts may also be formed,including hydrochloride, sulfate, nitrate, bicarbonate, and carbonatesalts.

Pharmaceutically acceptable salts of compounds may be obtained usingstandard procedures well known in the art, for example, by reacting asufficiently basic compound such as an amine with a suitable acidaffording a physiologically acceptable anion. Alkali metal (for example,sodium, potassium or lithium) or alkaline earth metal (for examplecalcium) salts of carboxylic acids can also be made.

Compositions of the invention, APCs, and others agents used in themethods of the invention may be locally administered at one or moreanatomical sites, such as sites of unwanted cell growth (such as a tumorsite, e.g., injected or topically applied to the tumor), optionally incombination with a pharmaceutically acceptable carrier such as an inertdiluent. Compositions of the invention, APCs, and other agents used inthe methods of the invention may be systemically administered, such asintravenously or orally, optionally in combination with apharmaceutically acceptable carrier such as an inert diluent, or anassimilable edible carrier for oral delivery. They may be enclosed inhard or soft shell gelatin capsules, may be compressed into tablets, ormay be incorporated directly with the food of the patient's diet. Fororal therapeutic administration, the agents may be combined with one ormore excipients and used in the form of ingestible tablets, buccaltablets, troches, capsules, elixirs, suspensions, syrups, wafers,aerosol sprays, and the like.

The tablets, troches, pills, capsules, and the like may also contain thefollowing: binders such as gum tragacanth, acacia, corn starch orgelatin; excipients such as dicalcium phosphate; a disintegrating agentsuch as corn starch, potato starch, alginic acid and the like; alubricant such as magnesium stearate; and a sweetening agent such assucrose, fructose, lactose or aspartame or a flavoring agent such aspeppermint, oil of wintergreen, or cherry flavoring may be added. Whenthe unit dosage form is a capsule, it may contain, in addition tomaterials of the above type, a liquid carrier, such as a vegetable oilor a polyethylene glycol. Various other materials may be present ascoatings or to otherwise modify the physical form of the solid unitdosage form. For instance, tablets, pills, or capsules may be coatedwith gelatin, wax, shellac, or sugar and the like. A syrup or elixir maycontain the active compound, sucrose or fructose as a sweetening agent,methyl and propylparabens as preservatives, a dye and flavoring such ascherry or orange flavor. Of course, any material used in preparing anyunit dosage form should be pharmaceutically acceptable and substantiallynon-toxic in the amounts employed. In addition, the compositions andagents may be incorporated into sustained-release preparations anddevices.

The active agents (e.g., APCs comprising variant survivin polypeptide)may also be administered intradermally, intravenously, orintraperitoneally by infusion or injection. In some embodiments, theAPCs are administered by intradermal injection, such as at an anatomicalsite that drains to the axillary and/or inguinal lymph node basins ofthe subject. Solutions of the active agents can be prepared in water,optionally mixed with a nontoxic surfactant. Dispersions can also beprepared in glycerol, liquid polyethylene glycols, triacetin, andmixtures thereof and in oils. Under ordinary conditions of storage anduse, these preparations can contain a preservative to prevent the growthof microorganisms.

The pharmaceutical dosage forms suitable for injection or infusion caninclude sterile aqueous solutions or dispersions or sterile powderscomprising the APCs of the invention which are adapted for theextemporaneous preparation of sterile injectable or infusible solutionsor dispersions, optionally encapsulated in liposomes. The ultimatedosage form should be sterile, fluid and stable under the conditions ofmanufacture and storage. The liquid carrier or vehicle can be a solventor liquid dispersion medium comprising, for example, water, ethanol, apolyol (for example, glycerol, propylene glycol, liquid polyethyleneglycols, and the like), vegetable oils, nontoxic glyceryl esters, andsuitable mixtures thereof. The proper fluidity can be maintained, forexample, by the formation of liposomes, by the maintenance of therequired particle size in the case of dispersions or by the use ofsurfactants. Optionally, the prevention of the action of microorganismscan be brought about by various antibacterial and antifungal agents, forexample, parabens, chlorobutanol, phenol, sorbic acid, thimerosal, andthe like. In many cases, it will be preferable to include isotonicagents, for example, sugars, buffers or sodium chloride. Prolongedabsorption of the injectable compositions can be brought about by theinclusion of agents that delay absorption, for example, aluminummonostearate and gelatin.

Sterile injectable solutions are prepared by incorporating thecompositions, APCs, and other agents in the required amount in theappropriate solvent with various other ingredients enumerated above, asrequired, followed by filter sterilization. In the case of sterilepowders for the preparation of sterile injectable solutions, thepreferred methods of preparation are vacuum drying and the freeze dryingtechniques, which yield a powder of the active ingredient plus anyadditional desired ingredient present in the previously sterile-filteredsolutions.

For topical administration, the compositions and agents may be appliedin pure-form, i.e., when they are liquids. However, it will generally bedesirable to administer them topically to the skin as compositions, incombination with a dermatologically acceptable carrier, which may be asolid or a liquid.

Useful solid carriers include finely divided solids such as talc, clay,microcrystalline cellulose, silica, alumina and the like. Useful liquidcarriers include water, alcohols or glycols or water-alcohol/glycolblends, in which the peptide can be dissolved or dispersed at effectivelevels, optionally with the aid of non-toxic surfactants. Additives suchas fragrances and additional antimicrobial agents can be added tooptimize the properties for a given use. The resultant liquidcompositions can be applied from absorbent pads, used to impregnatebandages and other dressings, or sprayed onto the affected area usingpump-type or aerosol sprayers, for example.

Thickeners such as synthetic polymers, fatty acids, fatty acid salts andesters, fatty alcohols, modified celluloses or modified mineralmaterials can also be employed with liquid carriers to form spreadablepastes, gels, ointments, soaps, and the like, for application directlyto the skin of the user. Examples of useful dermatological compositionswhich can be used to deliver the peptides to the skin are disclosed inJacquet et al. (U.S. Pat. No. 4,608,392), Geria (U.S. Pat. No.4,992,478), Smith et al. (U.S. Pat. No. 4,559,157) and Woltzman (U.S.Pat. No. 4,820,508).

Useful dosages of the pharmaceutical compositions of the presentinvention can be determined by comparing their in vitro activity, and invivo activity in animal models. Methods for the extrapolation ofeffective dosages in mice, and other animals, to humans are known to theart; for example, see U.S. Pat. No. 4,938,949.

Accordingly, the present invention includes a pharmaceutical compositioncomprising APCs comprising variant survivin polypeptides or encodingnucleic acid sequences in combination, optionally, with apharmaceutically acceptable carrier. Pharmaceutical compositions adaptedfor oral, topical or parenteral administration, comprising an amount ofa compound of the invention constitute a preferred embodiment of theinvention. The dose administered to a patient, particularly a human, inthe context of the present invention should be sufficient to achieve atherapeutic response in the patient over a reasonable time frame,without lethal toxicity, and preferably causing no more than anacceptable level of side effects or morbidity. One skilled in the artwill recognize that dosage will depend upon a variety of factorsincluding the condition (health) of the subject, the body weight of thesubject, kind of concurrent treatment, if any, frequency of treatment,therapeutic ratio, as well as the severity and stage of the pathologicalcondition. Advantageously, in some embodiments, administration of thecompounds of the invention does not induce weight loss or overt signs oftoxicity in the subject.

Depending upon the disorder or disease condition to be treated (e.g., amalignancy such as myeloma), a suitable dose(s) may be that amount thatwill reduce proliferation or growth of the target cell(s), or inducecell death. In the context of cancer, a suitable dose(s) is that whichwill result in a concentration of the active agent in cancer tissue,such as a malignant tumor, which is known to achieve the desiredresponse. The preferred dosage is the amount which results in maximuminhibition of cancer cell growth, without unmanageable side effects.Administration of APCs and other agents can be continuous or at distinctintervals, as can be determined by a person of ordinary skill in theart.

To provide for the administration of such dosages for the desiredtherapeutic treatment, in some embodiments, pharmaceutical compositionsof the invention can comprise between about 0.1% and 45%, andespecially, 1 and 15%, by weight of the total of one or more of theagents of the invention based on the weight of the total compositionincluding carrier or diluents. Illustratively, dosage levels of theadministered active ingredients can be: intravenous, 0.01 to about 20mg/kg; intraperitoneal, 0.01 to about 100 mg/kg; subcutaneous, 0.01 toabout 100 mg/kg; intramuscular, 0.01 to about 100 mg/kg; orally 0.01 toabout 200 mg/kg, and preferably about 1 to 100 mg/kg; intranasalinstillation, 0.01 to about 20 mg/kg; and aerosol, 0.01 to about 20mg/kg of animal (body) weight.

Dendritic Cell Preparation

Antigen presenting cells (APC) are important in eliciting an effectiveimmune response. APC not only present antigens to T cells withantigen-specific receptors, but also provide the signals necessary for Tcell activation. Such signals remain incompletely defined, but are knownto involve a variety of cell surface molecules as well as cytokines orgrowth factors. The factors necessary for the activation of naive orunprimed T cells may be different from those required for there-activation of previously primed memory T cells. Although monocytesand B cells have been shown to be competent APC, their antigenpresenting capacities appear to be limited to the re-activation ofpreviously sensitized T cells. Hence, they are not capable of directlyactivating functionally naive or unprimed T cell populations. On theother hand, dendritic cells are capable of both activating naive andpreviously primed T cells.

Dendritic cells have a distinctive morphology and a widespread tissuedistribution, including blood. The cell surface of dendritic cells isunusual, with characteristic veil-like projections. Mature dendriticcells are generally identified as CD3−, CD11c+, CD19−, CD83+, CD86+ andHLA-DR+.

Dendritic cells process and present antigens, and stimulate responsesfrom naive and unprimed T cells and memory T cells. In particular,dendritic cells have a high capacity for sensitizing MHC-restricted Tcells and are very effective at presenting antigens to T cells, bothself-antigens during T cell development and tolerance, and foreignantigens during an immune response. In addition to their role in antigenpresentation, dendritic cells also directly communicate with non-lymphtissue and survey non-lymph tissue for an injury signal (e.g., ischemia,infection, or inflammation) or tumor growth. Once signaled, dendriticcells initiate an immune response by releasing cytokines that stimulateactivity of lymphocytes and monocytes.

Due to their effectiveness at antigen presentation, dendritic cells maybe used as an immunostimulatory agent, both in vivo and ex vivo. The useof isolated dendritic cells as immunostimulatory agents has beenlimited, however, due to the low frequency of dendritic cells inperipheral blood and the low purity of dendritic cells isolated by priormethods. In particular, the frequency of dendritic cells in humanperipheral blood has been estimated at about 0.1% of the white cells.Similarly, there is limited accessibility of dendritic cells from othertissues, such as lymphoid organs. The low frequency of dendritic cellshas increased interest in isolating cell population enriched indendritic cell precursors, and culturing these precursors ex vivo or invitro to obtain enriched populations of immature or mature dendriticcells. Because the characteristics of dendritic cell precursors remainincompletely defined, methods typically used for isolating dendriticcell precursors do not result in purified fractions of the desiredprecursors, but instead generally produce mixed populations ofleukocytes enriched in dendritic cell precursors. Several cell typeshave been identified as having the potential to function as dendriticcell precursors. Blood-derived CD14+ monocytes, especially those thatexpress on their surface the receptor for the growth factorgranulocyte-monocyte colony stimulating factor (GM-CSF) are knowndendritic cell precursors. Other blood-derived dendritic cell precursorscan be isolated by first removing monocytes and other “non-dendriticcell precursors.” (See, e.g., U.S. Pat. Nos. 5,994,126 and 5,851,756.).Other known dendritic cell precursors include bone marrow-derived cellsthat express the CD34 cell surface marker.

Cell populations enriched in dendritic cell precursors have beenobtained by various methods and may be utilized with the invention, suchas, for example, density gradient separation, fluorescence activatedcell sorting, immunological cell separation techniques, e.g., panning,complement lysis, rosetting, magnetic cell separation techniques, nylonwool separation, and combinations of such methods. (See, e.g., O'Dohertyet al., J. Exp. Med. 178:1067-76 (1993); Young and Steinman, J. Exp.Med. 171:1315-32 (1990); Freudenthal and Steinman, Proc. Natl. Acad.Sci. USA 87:7698-702 (1990); Macatonia et al., Immunol. 67:285-89(1989); Markowicz and Engleman, J. Clin. Invest. 85:955-61 (1990) allincorporated herein by reference in their entirety). Methods forimmuno-selecting dendritic cells include, for example, using antibodiesto cell surface markers associated with dendritic cell precursors, suchas anti-CD34 and/or anti-CD14 antibodies coupled to a substrate. (See,e.g., Bernhard et al., Cancer Res. 55:1099-104 (1995); Caux et. al.,Nature 360:258-61 (1992)).

In one typical example method, leukocytes are isolated by aleukapheresis procedure. Additional methods are typically used forfurther purification to enrich for cell fractions thought to containdendritic cells and/or dendritic cell precursors. Similarly, methodssuch as differential centrifugation (e.g., isolation of a buffy coat),panning with monoclonal antibodies specific for certain cell surfaceproteins (e.g., positive and negative selection), and filtration alsoproduce a crude mixture of leukocytes containing dendritic cellprecursors.

Another reported method for isolating proliferating dendritic cellprecursors is to use a commercially treated plastic substrate (e.g.,beads or magnetic beads) to selectively remove adherent monocytes andother “non-dendritic cell precursors.” (See, e.g., U.S. Pat. Nos.5,994,126 and 5,851,756). The adherent monocytes and non-dendritic cellprecursors are discarded while the non-adherent cells are retained forex vivo culture and maturation. In another method, apheresis cells werecultured in plastic culture bags to which plastic, i.e., polystyrene orstyrene, microcarrier beads were added to increase the surface area ofthe bag. The cells were cultured for a sufficient period of time forcells to adhere to the beads and the non-adherent cells were washed fromthe bag. (Maffei, et al., Transfusion 40:1419-1420 (2000); WO 02/44338,incorporated herein by reference).

Subsequent to essentially all of the reported methods for thepreparation of a cell population enriched for dendritic cell precursors,the cell populations are typically cultured ex vivo or in vitro fordifferentiation of the dendritic cell precursors or maintenance, and/orexpansion of the dendritic cells. Briefly, ex vivo differentiation ofmonocytic dendritic cell precursors has involved culturing the mixedcell populations enriched for dendritic cell precursors in the presenceof combinations of cellular growth factors, such as cytokines. Forexample, monocytic dendritic cell precursors requiregranulocyte/monocyte colony-stimulating factor (GM-CSF) in combinationwith at least one other cytokine selected from, for example, eitherInterleukin 4 (IL-4), Interleukin 15 (IL-15), Interleukin 13 (IL-13),interferon α (IFN-α), and the like, to differentiate the cells into anoptimal state for antigen uptake, processing, and/or presentation. Thenumbers of dendritic cells from non-monocytic dendritic cell precursors,such as those obtained by removal of monocytes and other non-dendriticprecursor cells (adsorption to a plastic surface) or selection for CD34+cells, have also been expanded by culture in the presence of certaincytokines. Either GM-CSF alone or a combination of GM-CSF and IL-4 havebeen used in methods to produce dendritic cell populations from suchproliferating dendritic cell precursors for therapeutic use.

The effectiveness of such ex vivo differentiation, maintenance and/orexpansion has been limited, however, by the quality of the startingpopulation enriched in dendritic cells and dendritic cell precursors.Under some culture conditions, populations of dendritic cells anddendritic cell precursors that are heavily contaminated withneutrophils, macrophages and lymphocytes, or combinations thereof, canbe overtaken by the latter cells, resulting in a poor yield of dendriticcells. Culture of dendritic cells containing large numbers ofneutrophils, macrophages and lymphocytes, or combinations thereof, areless suitable for use as immunostimulatory preparations.

Immature or mature dendritic cells, once obtained, may optionally beexposed to a target antigen(s) (such as the variant survivinpolypeptide) and maturation agents to provide activated mature dendriticcells. In general, the antigen has been added to a cell populationenriched for immature or mature dendritic cells under suitable cultureconditions. In the case of immature dendritic cells, the cells are thenallowed sufficient time to take up and process the antigen, and expressantigenic peptides on the cell surface in association with either WICclass I or class II markers. Antigen can be presented to immaturedendritic cells on the surface of cells, in purified form, in asemi-purified form, such as an isolated protein or fusion protein (e.g.,a GM-CSF-antigen fusion protein), as a membrane lysate, as aliposome-protein complex, and other methods. In addition, as maturedendritic cells are not capable of taking up and processing antigen,antigenic peptides that bind to WIC class I or WIC class II moleculescan be added to mature dendritic cells for presentation.

APCs such as dendritic cells can be administered to a subject tostimulate an immune response by bolus injection, by continuous infusion,sustained release from implants, or other suitable techniques known inthe art. The APCs also can be co-administered with physiologicallyacceptable carriers, excipients, buffers and/or diluents. Further, APCscan be used to activate T cells, e.g., cytotoxic T cells, ex vivo usingmethods well known to the skilled artisan. The antigen specificcytotoxic T cells can then be administered to a patient to treat, forexample, a growing tumor, or a bacterial or viral infection. Thesecompositions can be used by themselves or as an adjuvant to othertherapies, such as, for example, surgical resection, chemotherapy,radiation therapy, and combinations thereof, as well as othertherapeutic modalities appropriate for the condition being treated.

Definitions

The terms “comprising”, “consisting of” and “consisting essentially of”are defined according to their standard meaning. The terms may besubstituted for one another throughout the instant application in orderto attach the specific meaning associated with each term.

The terms “isolated” or “biologically pure” refer to material that issubstantially or essentially free from components which normallyaccompany the material as it is found in its native state. Thus,compounds in accordance with the invention preferably do not containmaterials normally associated with the peptides in their in situenvironment.

As used in this specification, the singular forms “a”, “an”, and “the”include plural reference unless the context clearly dictates otherwise.Thus, for example, a reference to “a compound” includes more than onesuch compound. A reference to “a cell” includes more than one such cell,and so forth.

The practice of the present invention can employ, unless otherwiseindicated, conventional techniques of molecular biology, microbiology,recombinant DNA technology, electrophysiology, and pharmacology that arewithin the skill of the art. Such techniques are explained fully in theliterature (see, e.g., Sambrook, Fritsch & Maniatis, Molecular Cloning:A Laboratory Manual, Second Edition (1989); DNA Cloning, Vols. I and II(D. N. Glover Ed. 1985); Perbal, B., A Practical Guide to MolecularCloning (1984); the series, Methods In Enzymology (S. Colowick and N.Kaplan Eds., Academic Press, Inc.); Transcription and Translation (Hameset al. Eds. 1984); Gene Transfer Vectors For Mammalian Cells (J. H.Miller et al. Eds. (1987) Cold Spring Harbor Laboratory, Cold SpringHarbor, N.Y.); Scopes, Protein Purification: Principles and Practice(2nd ed., Springer-Verlag); and PCR: A Practical Approach (McPherson etal. Eds. (1991) IRL Press)), each of which are incorporated herein byreference in their entirety.

Some embodiments of the antigen presenting cells comprise a nucleic acidsequence encoding a variant survivin polypeptide, wherein the variantsurvivin polypeptide comprises at least consecutive amino acids 16-87(N-terminal zinc-binding baculovirus inhibitor of apoptosis proteinrepeat (BIR) domain) of the human wild-type survivin polypeptide (SEQ IDNO:1) modified to have an amino acid at position 34 which is other thanthreonine and an amino acid at position 84 which is other than cysteine,relative to the human wild-type survivin polypeptide, and wherein thevariant survivin polypeptide:

(a) comprises a 142-amino acid sequence having at least 80% sequenceidentity to the human wild-type survivin polypeptide (SEQ ID NO:1), or

(b) is a subsequence (fragment) of the human wild-type survivinpolypeptide (SEQ ID NO:1).

In some embodiments, the variant survivin polypeptide is a full lengthvariant of the survivin polypeptide (e.g., comprising or consisting ofSEQ ID NO:1), which allows for the presentation of multiple peptideepitopes and recognition by a more diverse immune repertoire acrosspatient populations.

In some embodiments, the variant survivin polypeptide is a subsequence(fragment) of the human wild-type polypeptide (SEQ ID NO:1). Accordingto the subject invention, a subsequence or “fragment” is a polypeptidethat is one or more amino acids less than the full length sequence, suchas the full length human sequence. Fragments contain one or more aminoacid deletions relative to the full-length wild-type sequence. Deletionsmay occur at either end of the polypeptide, or within the polypeptideamino acid sequence. In some embodiments, the fragment is 40, 41, 42,43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60,61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78,79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96,97, 98, 99, 100, 101, 102, 103, 104, 105, 106, 107, 108, 109, 110, 111,112, 113, 114, 115, 116, 117, 118, 119, 120, 121, 122, 123, 124, 125,126, 127, 128, 129, 130, 131, 132, 133, 134, 135, 136, 137, 138, 139,140, or 141 consecutive amino acids. Polypeptides according to theinstant invention may also contain non-natural amino acids, as will bedescribed below.

A “variant” or “modified” survivin polypeptide (or polypeptide variant)is to be understood to designate polypeptides exhibiting, in relation tothe natural polypeptide, certain modifications. These modifications caninclude a deletion, addition, or substitution of at least one aminoacid, a truncation, an extension, a chimeric fusion, a mutation, orpolypeptides exhibiting post-translational modifications. Among thehomologous polypeptides, those whose amino acid sequences exhibitbetween at least (or at least about) 80.00% to 99.99% (inclusive)identity to the full length, native, or naturally occurring polypeptideare another aspect of the invention. The aforementioned range of percentidentity is to be taken as including, and providing written descriptionand support for, any fractional percentage, in intervals of 0.01%,between 80.00% and, up to, including 99.99% (e.g., 80, 81, 82, 83, 84,85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, or 99%) sequenceidentity. These percentages are purely statistical and differencesbetween two polypeptide sequences can be distributed randomly and overthe entire sequence length.

Preferably, fragments (subsequences) and variants (sequences with lessthan 100% sequence identity) of the human double mutant survivinpolypeptide (e.g., SEQ ID NO:2 and SEQ ID NO:3) retain the ability toinduce the same or similar immune in a subject (e.g., a CD4+ immuneresponse).

The L-form of an amino acid residue is represented by a capital singleletter or a capital first letter of a three-letter symbol, and theD-form, for those amino acids having D-forms, is represented by a lowercase single letter or a lower case three letter symbol. Glycine has noasymmetric carbon atom and is simply referred to as “Gly” or G. Symbolsfor the amino acids are as follows: (Single Letter Symbol; Three LetterSymbol Amino Acid) A; Ala; Alanine: C; Cys; Cysteine: D; Asp; AsparticAcid: E; Glu; Glutamic Acid: F; Phe; Phenylalanine: G; Gly; Glycine: H;His; Histidine: I; Ile; Isoleucine: K; Lys; Lysine: L; Leu; Leucine: M;Met; Methionine: N; Asn; Asparagine: P; Pro; Proline: Q; Gln; Glutamine:R; Arg; Arginine: S; Ser; Serine: T; Thr; Threonine: V; Val; Valine: W;Trp; Tryptophan: Y; Tyr; Tyrosine.

Amino acid “chemical characteristics” are defined as: Aromatic (F, W,Y); Aliphatic-hydrophobic (L, I, V, M); Small polar (S, T, C); Largepolar (Q, N); Acidic (D, E); Basic (R, H, K); Non-polar: Proline;Alanine; and Glycine.

In order to extend the life of the polypeptides according to theinvention, it may be advantageous to use non-natural amino acids, forexample in the D-form, or alternatively amino acid analogs, for examplesulfur-containing forms of amino acids in the production of “variantpolypeptides”. Alternative means for increasing the life of polypeptidescan also be used in the practice of the instant invention. For example,polypeptides of the invention, and fragments thereof, can berecombinantly modified to include elements that increase the plasma, orserum half-life of the polypeptides of the invention. These elementsinclude, and are not limited to, antibody constant regions (see forexample, U.S. Pat. No. 5,565,335, hereby incorporated by reference inits entirety, including all references cited therein), or other elementssuch as those disclosed in U.S. Pat. Nos. 6,319,691, 6,277,375, or5,643,570, each of which is incorporated by reference in its entirety,including all references cited within each respective patent.Alternatively, the polynucleotides and genes of the instant inventioncan be recombinantly fused to elements, well known to the skilledartisan, that are useful in the preparation of immunogenic constructsfor the purposes of vaccine formulation.

The term “sequence identity” indicates a quantitative measure of thedegree of homology between two amino acid sequences or between twonucleic acid sequences of equal length. If the two sequences to becompared are not of equal length, they must be aligned to give the bestpossible fit, allowing the insertion of gaps or, alternatively,truncation at the ends of the polypeptide sequences or nucleotidesequences.

With respect all embodiments of the invention relating to nucleotidesequences, the percentage of sequence identity between one or moresequences may also be based on alignments using any suitable softwaresuch as the clustalW software (http:/www.ebi.ac.uk/clustalW/index.html)with default settings. For nucleotide sequence alignments these settingsare: Alignment=3Dfull, Gap Open 10.00, Gap Ext. 0.20, Gap separationDist. 4, DNA weight matrix: identity (IUB). Alternatively, and asillustrated in the examples, nucleotide sequences may be analysed usingany suitable software such as DNASIS Max and the comparison of thesequences may be done at http://www.paralicin.orci/. This service isbased on the two comparison algorithms called Smith-Waterman (SW) andParAlign. The first algorithm was published by Smith and Waterman (1981)and is a well established method that finds the optimal local alignmentof two sequences. The other algorithm, ParAlign, is a heuristic methodfor sequence alignment; details on the method is published in Rognes(2001). Default settings for score matrix and Gap penalties as well asE-values were used.

When referring to complementary sequences, the following base pairingrules can be applied, G pairs to C and U, A pairs to T and U. “Nucleicacids sequence” and “polynucleotide sequence” are interchangeable termsin the context of the present invention.

The term “vector” refers to a DNA molecule used as a vehicle to transferrecombinant genetic material into a host cell. The four major types ofvectors are plasmids, bacteriophages and other viruses, cosmids, andartificial chromosomes. The vector itself is generally a DNA or RNAsequence that consists of an insert (a heterologous nucleic acidsequence, transgene) and a larger sequence that serves as the “backbone”of the vector. The purpose of a vector which transfers geneticinformation to the host is typically to isolate, multiply, or expressthe insert in the target cell. Vectors called expression vectors(expression constructs) are specifically adapted for the expression ofthe heterologous sequences in the target cell, and generally have apromoter sequence that drives expression of the heterologous sequences.Simpler vectors called transcription vectors are only capable of beingtranscribed but not translated: they can be replicated in a target cellbut not expressed, unlike expression vectors. Transcription vectors areused to amplify the inserted heterologous sequences. The transcripts maysubsequently be isolated and used as templates suitable for in vitrotranslation systems.

The choice of vector employed in embodiments of the present inventiondepends on the specific application of the vector encoding thepolypeptides or polynucleotide of the invention. In some embodiments,the vector is a viral vector. In other embodiments, the vector is anon-viral vector.

The term “operatively linked” refers to the connection of elements beinga part of a functional unit such as a gene or an open reading frame(e.g., encoding a variant survivin polypeptide described herein).Accordingly, by operatively linking a promoter to a nucleic acidsequence encoding a variant survivin polypeptide the two elementsbecomes part of the functional unit—a gene. The linking of theexpression control sequence (promoter) to the nucleic acid sequenceenables the transcription of the nucleic acid sequence directed by thepromoter. Expression control sequences can be linked to a nucleic acidsequence encoding the variant survivin polypeptide with an expressionconstruct. By operatively linking two heterologous nucleic acidsequences encoding a polypeptide the sequences becomes part of thefunctional unit—an open reading frame encoding a fusion proteincomprising the amino acid sequences encoding by the heterologous nucleicacid sequences. By operatively linking two amino acids sequences, thesequences become part of the same functional unit—a polypeptide.Operatively linking two heterologous amino acid sequences generates ahybrid (fusion) polypeptide. Thus, fusions of a variant survivinpolypeptide and another heterologous polypeptide can be produced, ormultimers of variant survivin polypeptides can be produced. Optionally,fused polypeptides can be separated by cleavage sites intended to betargeted for cleavage, e.g., in vivo.

Materials and Methods for Examples 1-5

Sample Collection.

Healthy donor blood samples were provided as buffy coats from One Blood(St. Petersburg, Fla.). Multiple myeloma patient blood and bone marrowaspirate was collected at Moffitt Cancer Center (Tampa, Fla.) afterinformed consent to an IRB approved sample collection study (MCC 16617).Mononuclear cells were isolated from blood and bone marrow using densitygradient centrifugation over Ficoll-Paque PLUS (GE Healthcare, LittleChalfont, UK).

Tumor Cell Isolation.

CD138+ plasma cells were selected from mononuclear bone marrow cells ofmultiple myeloma patients using magnetic column separation. Cells wereincubated with CD138+ microbeads (Miltenyi, Germany) for 15 minutes,washed and eluted over an MS or LS column (Miltenyi). CD138+ cellsretained in the column were collected and purity of >90% was verified byflow cytometry.

Dendritic Cell Generation and Peptide Pool Loading.

Dendritic cells (DCs) were generated by suspending 7-11×10⁶ PBMCs/mL inserum-free XVIVO-15 media (Lonza, Allendale, N.J.) followed by 3 hourculture in a 25 cm² cell culture flask (Corning, Corning, N.Y.). Cellswere then washed twice in PBS to remove non-adherent cells. Adherentcells were cultured in serum-free X-VIVO media supplemented with 1000units/ml each of GM-CSF and IL-4 (R&D Systems, Minneapolis, Minn.) forsix days. DCs were then collected, washed and counted. DCs were loadedwith the indicated peptide pool by incubating for one hour at 37° C. in100 μl XVIVO-15 media supplemented with 1 μg/peptide/ml then used forexperiments. PEPMIX™ Peptide pools were synthesized by the manufacturer(JPT, Germany). The survivin peptide pool consists of 33 peptidesderived from a peptide scan (15 mers with 11 aa overlap) throughBaculoviral IAP repeat-containing protein 5 (Survivin). Positive controlpeptide pools included CEFT MHCII (14 peptides each corresponding to adefined HLA class II restricted T-cell epitope from Cytomegalovirus,Epstein-Barr virus, Influenza virus or Clostridium tetani) and HCMVA(pp65) sourced from the 65 kDa lower matrix phosphoprotein of humancytomegalovirus (strain AD169). The HIV-1 peptide pool (123 peptidesselected from Con B gag motifs of HIV), or vehicle only, were used asnegative controls as indicated.

T Cell Isolation.

For all experiments, CD4+CD25− T cells were isolated by using magneticbeads from a CD4 negative selection kit supplemented by CD25+ microbeadsper the manufacturer's protocol (Miltenyi). PBMCs were incubated for 10minutes with a biotin-antibody cocktail including CD8, CD14, CD15, CD16,CD19, CD36, CD56, CD123, TCR γ/δ, and CD235a (Glycophorin A) followed bya 15 minute incubation with both anti-biotin and anti-CD25 microbeads.Labeled cells were passed through an LS column and the negative fractionwas collected for use in T cell assays.

Proliferation Assay.

[³H]thymidine incorporation assay was performed as previously described(23). Briefly, CD4+CD25− T cells were suspended in X-VIVO-15 (Lonza)media supplemented with 10% human serum (SeraCare, Milford, Mass.) andpenicillin/streptomycin, then seeded into a 96 well flat bottom plate ina ratio of 10:1 with loaded or unloaded DCs. Wells were supplementedwith 10 units/ml of IL-2 (R&D Systems) on day 0 and cultured at 37° C.for six days. On day 6 wells were pulsed with radioactive thymidine(PerkinElmer Waltham, Mass.) for 6 hours then harvested using aFiltermate cell harvester (PerkinElmer). Thymidine incorporation wasquantified using a TopCount NXT scintillation counter (PerkinElmer). Tocalculate the stimulation index 1×10⁵ CD4+CD25− T cells were stimulatedwith 1×10⁴ autologous DCs loaded with survivin (DC:survivin) in a 96well flat bottom tissue culture plate for 6 days. Proliferation for eachwell was determined as described above. The stimulation index for eachwell was calculated against T cells similarly stimulated using unloadedautologous DCs (>=10 replicates per donor). Stimulation Index=[1×10⁵CD4+CD25− T cells stimulated with 1×10⁴ DC:survivin (numerator)]/[Meanof >=10 DC:null stimulated T cell controls (denominator)].

Limiting Dilution Analysis.

The precursor frequencies of survivin-specific CD4+ T cells weredetermined by limiting dilution analysis as previously described (24).Briefly, CD4+CD25− cells were seeded into 96 well plates in a two-folddescending serial dilution ranging from 100,000 cells/well to 3,125cells/well in a flat bottom plate and 5,000 to 80 cells/well in a roundbottom plate with a total of 10 replicate wells at each concentration.These cells were cocultured with a fixed number of DCs (1×10⁴ for flatbottom plates or 2×10³ for round bottom) which were either loaded withthe survivin peptide pool (DC:survivin) or unloaded (DC:unloaded).Control wells contained the top concentration of T cells/well for thatplate or DCs alone (1×10⁴ or 2×10³). Cells were cultured at 37° C. forsix days in XVIVO-15 media supplemented with 10% human AB serum(SeraCare) and 10 units/ml IL-2 (R&D Systems). On day 6 [³H]thymidineincorporation assay was performed. Publically available extreme limitingdilution analysis software from Walter+Eliza Hall Bioinformatics(bioinfwehi.edu.au/software/elda/index.html) was used to calculate thefrequency and 95% confidence interval (95% CI) of replicating T cells.Wells were considered to be positive if cpm was greater than the meanplus three times the standard deviation of the mean of all unloaded DCcontrol wells (10 or more replicates) at that same T cell concentration.

IFNγ ELISA.

Supernatant was collected from each well and developed using an IFNγELISA kit (eBiosciences, San Diego, Calif.) per the manufacturer'sprotocol. Briefly, ELISA plates (9018, Corning Costar) were incubatedovernight at 4° C. with 1004, purified anti-human IFNγ. Plates werewashed and incubated with assay diluent for one hour at room temperatureto block the wells from non-specific binding. Plates were washed andincubated for two hours at room temperature with cell culturesupernatant or a standard curve created by performing a 2-fold serialdilution of a 500 pg/ml standard. Plates were washed and incubated atroom temperature for one hour with 100 μl biotin-conjugated anti-humanIFNγ. Plates were then washed again and incubated for 30 minutes at roomtemperature with 100 μl/well Avidin-HRP. Plates were washed anddeveloped with 100 W TMB substrate solution for 15 minutes. The reactionwas stopped by adding 50 μl/well of 1 M phosphoric acid. The ELISAplates were analyzed at 450 nanometers using a Versamax microplatereader equipped with SoftMax Pro 5 software (Molecular Devices,Sunnyvale, Calif.).

Quantitative PCR.

Messenger RNA was extracted from healthy donor PBMCs or multiple myelomapatient tumor cells by Trizol reaction per the manufacturer's protocol(Invitrogen, Grand Island, N.Y.). mRNA was quantified and assessed forpurity using a Nanodrop ND-1000 spectrophotometer (Thermo Scientific,Waltham, Mass.). cDNA was created using a High Capacity cDNA reversetranscription kit according to the manufacturer's protocol (AppliedBiosystems, Waltham, Mass.). qPCR was performed using an AppliedBiosystems 7900 HT Fast Real-Time PCR system in MicroAmp optical 96-wellreaction plates using Taqman universal PCR master mix and primer-probesets for BIRC5 (survivin) and GAPDH genes (Applied Biosystems). Datawere analyzed using SDSv2.2.2 software from Applied Biosystems.

Dendritic Cell Transfection.

Following plastic adherent generation, DCs were re-suspended in 500 μLserum-free XVIVO-15 media supplemented with GM-CSF and IL-4 andtransfected with 20,000 viral particles/cell of adenovirus expressingdouble mutant full length survivin (T34A and C84A) for 2 hours at 37° C.(25). After 2 hours, 2×10⁵ DCs/well were seeded into 24 well plates andsupplemented with 1.5 ml of complete culture media (XVIVO-15+10% humanserum (SeraCare)+Penicillin/Streptomycin) for an additional 24 hours.

T Cell Expansion.

2×10⁶ CD4+CD25− T cells/well isolated by magnetic bead negativeselection were seeded into 24 well plates containing DCs transfectedwith survivin adenovirus, peptide pool loaded DCs or unloaded DCs incomplete culture media (CCM) supplemented with 10 units/ml IL-2 (R&DSystems). Cells were cultured for 12 days then T cells were collected,washed, counted and re-suspended in CCM without cytokines and rested for48 hours before use in limiting dilution analysis.

All patents, patent applications, provisional applications, andpublications referred to or cited herein are incorporated by referencein their entirety, including all figures and tables, to the extent theyare not inconsistent with the explicit teachings of this specification.

Following are examples that illustrate procedures for practicing theinvention. These examples should not be construed as limiting. Allpercentages are by weight and all solvent mixture proportions are byvolume unless otherwise noted.

Example 1—Human CD4+ T Cells Exhibit a Survivin Specific Response

The response of unprimed conventional human CD4+CD25− T cells againstsurvivin was evaluated by quantifying proliferation and IFN-gammacytokine release against a peptide pool (JPT) derived from survivin.Because the peptides are not restricted to a single HLA type, testing ofhuman T cells does not require HLA typing and stratification since thelikelihood of detecting a response is magnified by the pool of peptides.CD4+CD25− T cells from healthy patients proliferate in response tosurvivin peptide pools loaded onto autologous monocyte derived dendriticcells, similar to responses against common viral antigens (FIG. 1A).After 6 days of co-culture, IFN-gamma was detectable within thesupernatant (FIG. 1B). To evaluate the reactivity of healthy donor CD4+cells against survivin the inventors determined the stimulation indexfor 10 consecutive healthy donors (3-12 replicates per donor). CD4+proliferative response against survivin was detectable in all 10 healthydonors tested (FIG. 1C). Not every well containing 100,000 CD4+ cellsexhibited proliferative responses exceeding the autologous mixedlymphocyte response.

Example 2—Limiting Dilution Analysis Quantifies the Frequency ofSurvivin-Reactive CD4+ T Cells

To quantify the precursor frequency of survivin-specific T cells theinventors performed limiting dilution analysis (LDA) of CD4+CD25− Tcells against a fixed dendritic cell concentration (FIG. 2A, Before). Tovalidate that the proliferation measured in the LDA was indeed due toreactivity specifically against survivin, CD4+CD25− T cells wereconcurrently expanded, under the same conditions, for 12 days. RepeatLDA showed the frequency of survivin-responsive T cells increasedapproximately 100-fold (FIG. 2A, After), and the absolutesurvivin-specific cell number increased 200-fold (data not shown). Theinventors next confirmed that T cells expanded using DC:survivin wereable to secrete IFN-gamma in response to survivin. Before initialDC:survivin stimulation, CD4+CD25+ cells were labeled with theproliferative marker cell trace violet (CTV). Following 12 days ofexpansion with DC:survivin, CD4+ cells were flow sorted into CTV−(replicated) and CTV+(non-replicated) populations. Replicated T cellsshowed a significant secretion of IFN-gamma (FIG. 2B) upon re-challengewith DC:survivin as compared to DCs loaded with an irrelevant HIVprotein peptide pool (DC:HIV). Non-replicated CD4+ T cells did notrespond to either peptide pool stimulus.

Example 3—Multiple Myeloma Patients have Fewer Survivin-Reactive CD4+ TCells than Healthy Blood Donors

It was previously shown that myeloma patients can harbor CD4 and CD8 Tcells reactive against survivin; however, this required multiplestimulation and expansion steps, precluding a precise quantification ofthe circulating T cell precursor frequency. The inventors next evaluatedthe precursor frequency of survivin-reactive T cells in the peripheralblood of 10 consecutive healthy donors and 12 consecutive multiplemyeloma patients. Myeloma patients had a significantly lower precursorfrequency of survivin-reactive CD4+CD25− cells (range 0% to 2.2×10-3%)compared to healthy donors (range 1.1×10-3 to 8.4×10-3%) (FIG. 3A).Similar to healthy donors, myeloma patient CD4+CD25− T cells expand inresponse to DC:survivin stimulation (FIGS. 3B-3C).

Example 4—Multiple Myeloma Tumor Survivin Expression InverselyCorrelates with Survivin-Reactive CD4+ T Cell Frequency

Purified CD138+ primary multiple myeloma patient tumor cells frompatients' bone marrow aspirates express survivin mRNA at a frequencysimilar to that described by others (FIG. 4A). Survivin protein also canbe detected by IHC from concordant bone marrow biopsies (data notshown). Survivin-specific precursor frequency and survivin mRNAtranscripts were evaluated for 6 consecutive MM patients having adequatesamples. There is an inverse correlation between a patient'ssurvivin-reactive CD4+CD25− precursor frequency and their tumor'ssurvivin expression by PCR (FIG. 4B).

Example 5—a Full-Length Survivin Protein Vaccine Elicits CD4+ T CellResponses in Myeloma Patients Despite Low Baseline Survivin-ReactiveCD4+ Precursor Frequencies

The inventors tested the ability of a full-length survivin proteinvaccine to expand myeloma CD4+CD25− T cells that are reactive againstsurvivin peptide pool loaded autologous DCs. The previouslycharacterized vaccine consists of an adenoviral construct (Ad-ms), whichupon infection of autologous DCs (DC:Ad-ms), leads to expression andantigen presentation of a mutated survivin protein. This approach allowsfor preservation of multiple epitopes, which upon DC antigenpresentation are more likely to capture and expand survivin-reactive Tcells than single or oligo-peptide survivin vaccines. Thesurvivin-reactive frequency was determined before and after myelomapatient CD4+CD25− T cells were co-cultured with autologous DCs infectedwith Ad-ms (FIG. 5A). Survivin-reactive CD4+ T cell frequency andabsolute number of survivin-reactive T cells (FIG. 5B) was increasedafter co-culture (fold expansion range 0-270×, median=42×). The vaccinewas able to expand survivin-reactive cells even from myeloma patientswith a low pre co-culture survivin-specific precursor frequency (near orbelow the limit of detection of the LDA assay). The survivin-reactiveprecursor frequency of CD4+CD25− cells was not predictive of the numberof survivin-reactive cells obtained after expansion (r=0.429, p=0.4194by Spearman correlation analysis).

It should be understood that the examples and embodiments describedherein are for illustrative purposes only and that various modificationsor changes in light thereof will be suggested to persons skilled in theart and are to be included within the spirit and purview of thisapplication and the scope of the appended claims. In addition, anyelements or limitations of any invention or embodiment thereof disclosedherein can be combined with any and/or all other elements or limitations(individually or in any combination) or any other invention orembodiment thereof disclosed herein, and all such combinations arecontemplated with the scope of the invention without limitation thereto.

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-   26. Weber G, Caruana I, Rouce R H, Barrett A J, Gerdemann U, Leen A    M, et al. Generation of tumor antigen-specific T cell lines from    pediatric patients with acute lymphoblastic leukemia—implications    for immunotherapy. Clin Cancer Res. 2013; 19:5079-91.-   27. de Haart S J, van de Donk N W, Minnema M C, Huang J H,    Aarts-Riemens T, Bovenschen N, et al. Accessory cells of the    microenvironment protect multiple myeloma from T-cell cytotoxicity    through cell adhesion-mediated immune resistance. Clin Cancer Res.    2013; 19:5591-601.-   28. Locke F L, Nishihori T, Alsina M, Kharfan-Dabaja M A.    Immunotherapy strategies for multiple myeloma: the present and the    future. Immunotherapy. 2013; 5:1005-20.-   29. Han S, Wang B, Cotter M J, Yang L J, Zucali J, Moreb J S, et al.    Overcoming immune tolerance against multiple myeloma with lentiviral    calnexin-engineered dendritic cells. Mol Ther. 2008; 16:269-79.-   30. Prabhala R H, Neri P, Bae J E, Tassone P, Shammas M A, Allam C    K, et al. Dysfunctional T regulatory cells in multiple myeloma.    Blood. 2006; 107:301-4.-   31. Beyer M, Kochanek M, Giese T, Endl E, Weihrauch M R, Knolle P A,    et al. In vivo peripheral expansion of naive CD4+CD25high FoxP3+    regulatory T cells in patients with multiple myeloma. Blood. 2006;    107:3940-9.-   32. Noonan K, Marchionni L, Anderson J, Pardoll D, Roodman G D,    Borrello I. A novel role of IL-17-producing lymphocytes in mediating    lytic bone disease in multiple myeloma. Blood. 2010; 116:3554-63.-   33. Gorgun G T, Whitehill G, Anderson J L, Hideshima T, Maguire C,    Laubach J, et al. Tumor-promoting immune-suppressive myeloid-derived    suppressor cells in the multiple myeloma microenvironment in humans.    Blood. 2013; 121:2975-87.-   34. Favaloro J, Liyadipitiya T, Brown R, Yang S, Suen H, Woodland N,    et al. Myeloid derived suppressor cells are numerically,    functionally and phenotypically different in patients with multiple    myeloma. Leuk Lymphoma. 2014:1-8.-   35. Ramachandran I R, Martner A, Pisklakova A, Condamine T, Chase T,    Vogl T, et al. Myeloid-derived suppressor cells regulate growth of    multiple myeloma by inhibiting T cells in bone marrow. J Immunol.    2013; 190:3815-23.-   36. Shain K H, Dalton W S. Environmental-mediated drug resistance: a    target for multiple myeloma therapy. Expert review of hematology.    2009; 2:649-62.-   37. Bonanno G, Mariotti A, Procoli A, Folgiero V, Natale D, De Rosa    L, et al. Indoleamine 2,3-dioxygenase 1 (IDO1) activity correlates    with immune system abnormalities in multiple myeloma. Journal of    translational medicine. 2012; 10:247.-   38. Prabhala R H, Pelluru D, Fulciniti M, Prabhala H K, Nanjappa P,    Song W, et al. Elevated IL-17 produced by TH17 cells promotes    myeloma cell growth and inhibits immune function in multiple    myeloma. Blood. 2010; 115:5385-92.-   39. Dhodapkar K M, Barbuto S, Matthews P, Kukreja A, Mazumder A,    Vesole D, et al. Dendritic cells mediate the induction of    polyfunctional human IL17-producing cells (Th17-1 cells) enriched in    the bone marrow of patients with myeloma. Blood. 2008; 112:2878-85.-   40. Tamura H, Ishibashi M, Yamashita T, Tanosaki S, Okuyama N, Kondo    A, et al. Marrow stromal cells induce B7-H1 expression on myeloma    cells, generating aggressive characteristics in multiple myeloma.    Leukemia. 2013; 27:464-72.-   41. Zheng Y, Zha Y, Driessens G, Locke F, Gajewski T F.    Transcriptional regulator early growth response gene 2 (Egr2) is    required for T cell anergy in vitro and in vivo. J Exp Med. 2012;    209:2157-63.-   42. Fields P E, Gajewski T F, Fitch F W. Blocked Ras activation in    anergic CD4+ T cells. Science. 1996; 271:1276-8.-   43. Brown R, Murray A, Pope B, Sze D, Gibson J, Ho P J, et al. B7+ T    cells in myeloma: an acquired marker of prior chronic antigen    presentation. Leuk Lymphoma. 2004; 45:363-71.-   44. Rosenblatt J, Glotzbecker B, Mills H, Vasir B, Tzachanis D,    Levine J D, et al. PD-1 blockade by CT-011, anti-PD-1 antibody,    enhances ex vivo T-cell responses to autologous dendritic    cell/myeloma fusion vaccine. J Immunother. 2011; 34:409-18.-   45. Brown R D, Pope B, Yuen E, Gibson J, Joshua D E. The expression    of T cell related costimulatory molecules in multiple myeloma. Leuk    Lymphoma. 1998; 31:379-84.-   46. Mesri M, Wall N R, Li J, Kim R W, Altieri D C. Cancer gene    therapy using a survivin mutant adenovirus. The Journal of clinical    investigation. 2001; 108:981-90.-   47. Pisarev V, Yu B, Salup R, Sherman S, Altieri D C, Gabrilovich    D I. Full-length dominant-negative survivin for cancer    immunotherapy. Clin Cancer Res. 2003; 9:6523-33.-   48. Lim S H, Badros A, Lue C, Barlogie B. Distinct T-cell clonal    expansion in the vicinity of tumor cells in plasmacytoma. Cancer.    2001; 91:900-8.

Example 6—T Cells Specific for Survivin are Decreased in MyelomaPatients Compared to Healthy Donors

Multiple myeloma is the second most common hematologic malignancy inadults with approximately 20,000 patients diagnosed per year in theUnited States.¹ The disease is characterized by the proliferation ofclonal plasma cells preferentially in the bone marrow, resulting inanemia, osteolytic bone disease and the detection of a monoclonalgammopathy in the majority of the patients.² The current standardtherapy consists of induction therapy with immunomodulatory drugs orproteasome inhibitor based-regimens, followed by autologous stem celltransplants in those patients with responsive disease.³⁻⁶ Thesetreatment modalities induce high rates of complete remission andsignificantly improved survival. However, molecular remissions are rare,and a significant proportion of patients are unable to achieve acomplete response (CR) to induction therapy both before and aftertransplant. Inevitably all patients relapse and die due to diseaseprogression.⁷ Therefore, the development of novel interventions forpatients with resistant disease and to target minimal residual diseaseafter autologous bone marrow transplantation is greatly needed.

Survivin is a small inhibitor of apoptosis protein that functions as amitotic regulator and an apoptosis inhibitor.⁸ The role of survivin inthe regulation of mitosis is linked to multiple spindle microtubulefunctions and mitotic checkpoints.⁹ Survivin is known to interfere withcaspase 9 processing, the upstream initiation of the intrinsic pathwayof apoptosis.¹⁰ Survivin is abundantly expressed in development, but isundetectable in most adult tissues, except for thymocytes, CD34 bonemarrow derived stem cells, and colonic epithelial cells.¹¹ In contrast,survivin is over expressed in almost all cancers including lung, colon,breast pancreas, stomach, liver, ovary, prostate, melanoma andhematologic malignancies.¹²⁻¹⁶ High survivin expression in cancer hasbeen shown to carry poor prognosis and has been consistently associatedwith advanced disease, drug resistance, early relapses and decreasedsurvival.¹⁷

Multiple studies have shown survivin over expression in myeloma cellslines and primary cells and a correlation of its expression to poorprognosis and drug resistance. Li et al. examined the RNA and proteinexpression of survivin in bone marrow of healthy individuals andmultiple myeloma patients.¹⁸ Survivin protein was not detected inhealthy individuals while it was expressed in 41.4% of newly diagnosedmyeloma patients and 58.3% of relapsed refractory patients. Their studyalso suggested a better response rate in patients without survivinexpression and these findings have been supported by otherinvestigators.⁷

In a study by Romagnoli et al¹⁹ a significant correlation was foundbetween survivin expression and myeloma progression with high survivinexpression in patients with relapsed and extramedullary myeloma whencompared to a cohort of newly diagnosed patients. In cell lines theywere able to show that silencing of survivin expression sensitizes themyeloma cells to cytotoxic chemotherapy such as doxorubicin,dexamethasone and melphalan. Grube et al.²⁰ provided evidence of T cellreactivity against survivin antigen in myeloma patients suggesting thatimmunotherapeutic strategies using survivin as a target antigen may beuseful in myeloma.

Multiple myeloma patients treated at Moffitt Cancer Center have tumorsexpressing survivin protein and mRNA. The inventors evaluated 28patients' bone marrow biopsies for the presence of tumor specificsurvivin expression. All biopsies were done as part of thepre-transplant evaluation (post induction chemotherapy) and all hadmeasurable disease in the marrow (>5% CD138+ cells). Using methodsdescribed in section 5.1, 9 of 28 patients (32%) were survivin positive,a rate similar to that described by others (FIG. 15A). In a separatecohort of 15 patients, the inventors purified CD138+ cells from bonemarrow aspirates. Quantitative PCR was performed revealing survivinexpression significantly greater than healthy donor PBMC controls in 60%of patients, and very high expression in 33% (FIG. 15B). Thispreliminary data shows that our patient population with less than a CRafter induction therapy does express both survivin protein and mRNA.

Survivin specific T cells exist in multiple myeloma patients (FIGS.10A-10B). The inventors evaluated the precursor frequency of survivinreactive T cells in the peripheral blood of 10 consecutive healthydonors and 12 consecutive multiple myeloma patients. Myeloma patientshad a significantly lower precursor frequency of survivin reactiveCD4+CD25− cells (range 0% to 2.2×10-3%) compared to healthy donors(range 1.1×10-3 to 8.4×10-3%) (FIG. 11A).

Our pre-cursor frequency assay utilizes T cell limiting dilutionanalysis with stimulation by autologous DC loaded with a survivinpeptide pool, or unloaded as a control. The pool consists of 15mers withan overlap of 11 amino acids spanning the entire survivin protein,synthesized, purified, and analyzed by liquid crystallography by themanufacturer, JPT (Germany). Patients need not be stratified by HLAtype, since the likelihood of detecting a response is magnified by thepool of peptides.^(21,22) This approach does not limit immune monitoringto patients with a certain HLA type, and will allow for measurement offunctional survivin specific CD4 or CD8 T cells in patients vaccinatedusing a whole survivin protein.

Example 7—Multiple Myeloma Tumor Survivin Expression InverselyCorrelates with Survivin Reactive CD4+ T Cell Frequency

Survivin specific T cell precursor frequency and tumor survivin mRNAtranscripts were evaluated for 6 consecutive MM patients having adequatesamples. There is an inverse correlation between a patient's survivinreactive CD4+CD25− precursor frequency and their tumor's survivinexpression by PCR (FIG. 11B).

Example 8—a Full Length Survivin Protein Vaccine Elicits T CellResponses in Myeloma Patients Despite Low Baseline Survivin Reactive TCell Precursor Frequencies

The inventors tested the ability of a full length survivin proteinvaccine to expand survivin reactive T cells from myeloma patients.

The previously described vaccine consists of an adenoviral construct(Ad-ms), which upon infection of autologous DCs (DC:Ad-ms), leads toexpression and antigen presentation of a mutated survivin protein. Thisapproach allows for preservation of multiple epitopes, which upon DCantigen presentation are more likely to capture and expand survivinreactive T cells than single or oligo-peptide survivin vaccines.

The survivin reactive frequency was determined before and after myelomapatient CD4+CD25− T cells were co-cultured with autologous DCs infectedwith Ad-ms. Survivin reactive CD4+ T cell frequency (not shown) andabsolute number of survivin reactive T cells (FIG. 12A) was increasedafter co-culture (fold expansion range 0-270×, median=42×). The vaccinewas able to expand survivin reactive cells even from myeloma patientswith a low pre co-culture survivin specific precursor frequency (near orbelow the limit of detection of the LDA assay). The survivin reactiveprecursor frequency of CD4+CD25− cells was not predictive of the numberof survivin reactive cells obtained after expansion (r=0.429, p=0.4194by Spearman correlation analysis).

Importantly CD3+ T cells expanded using the vaccine do not secreteIFN-gamma in response to irrelevant HIV protein peptide pools loaded onautologous DCs but do exhibit significant responses against survivin(FIG. 12B).

Both survivin antagonists and survivin peptide vaccines have beentested. Survivin antagonists developed for clinical testing include anantisense molecule (LY218130B), and transcriptional repressors (YM155and EM1421).^(23,24) Tolcher et al. completed a Phase I study of YM155in patients with advanced solid malignancies or lymphoma. In this study,Forty-one patients received this small molecule inhibitor of survivin atdoses ranging from 1.8-6.0 mg/m2/day for 168-h CIVI every 3 weeks.Overall the most common grade 1-2 toxicities were stomatitis, pyrexia,and nausea, whereas grade 3 and 4 toxicities were rare. The doselimiting toxicity was reversible renal insufficiency at 6.0 mg/m2. Therewas no myelosupression observed. Responses were seen in three patientswith Non-Hodgkin's lymphoma, two patients with refractory prostatecancer and one patient with non-small cell lung cancer.²⁵

Survivin is a good candidate for immunotherapy due to its key role incancer survival and the fact that is over expressed in cancer tissuesbut not in most normal tissues. However, the fact that survivin isexpressed in CD 34 hematopoietic stem cells raised concerns aboutpotential toxicity when used clinically. Nagaraj et al²⁶ evaluated thisrisk by using dendritic cells transduced with an adenovirus encodingmutant human survivin in preclinical studies. Immunization of mice withthis vaccine resulted in generation of CD8 Tells recognizing multipleepitopes from mouse survivin and these responses provided significantantitumor effect against EL-4 lymphoma, MC-38 carcinoma, and MethAsarcoma. No effects on the bone marrow hematopoietic progenitor cellswere observed suggesting that this is a safe and clinically feasibleapproach to target survivin. Other investigators have also tested theefficacy of targeting survivin with a DNA vaccine given to mice withNSCLC.²⁷ This vaccine encoded survivin and a chemokine known to beoverexpressed in the tumor blood vessels. The vaccine elicited aneffective CD8 T cell response against survivin and this resulted ineradication of pulmonary metastasis of NSCLC in mice.

The first survivin vaccine tested in the clinic was generated fromautologous dendritic cells (DCs) and tested in patients with non-smallcell lung cancer (NSCLC) by Hirschowitz et al.²⁸ In this study, 16patients with NSCLC were treated with autologous DC vaccines generatedfrom CD 14+ precursors, pulsed with apoptotic bodies of an allogeneicNSCLS cell line that over expressed survivin. The patients wereimmunized intra-dermaly 2 times, 1 month apart after they receivedinitial cytoreductive therapy in the form of surgery, chemoradiation, orboth. Peripheral blood was drawn serially after vaccination and immuneresponses measured by interferon-gamma ELISPOT. There were nounanticipated adverse events and six of 16 patients showed antigenspecific responses. This study suggests that this vaccine approach iswell tolerated and has biologic activity in this patient population.

Additional strategies targeting survivin using restricted peptidevaccines have demonstrated CD8 and CD4 immune responses withoutsignificant toxicities.²⁹⁻³¹

Despite high expectations, immunotherapy clinical trials performed inrecent years demonstrated very limited clinical efficacy.³² It appearsthat cancer immunotherapy is faced with a number of challenges. Theyinclude the ability of vaccination to generate potent immune responsesgiven the presence of numerous immunosuppressive factors, the ability ofcytotoxic T cells to penetrate tumor parenchyma and recognizetumor-associated antigen, and the correct choice of antigen forimmunization. It has become apparent that therapeutic cancer vaccinesgiven as a single agent will not likely produce substantial clinicalbenefits. An emerging strategy is one whereby multiple pathways of tumorcell survival and drug resistance are targeted by using immunotherapy incombination with chemotherapy or radiation therapy.^(33,34)

High dose chemotherapy with subsequent stem cell transplantation mayrepresent a therapeutic strategy, termed immunotransplant, can abrogatenegative effect of various immunosuppressive mechanisms. This approachcan dramatically reduce tumor burden and eliminate immunosuppressiveregulatory cells. If combined with vaccination it can induce cytotoxic Tcells against specific antigens in the malignant cells and exploit thehomeostatic T cell repopulation after high dose chemotherapy, resultingin enhanced T cell expansion and producing a robust, therapeutic immuneresponse against myeloma. Using a murine model, Brody et al.demonstrated that vaccination prior to hematopoietic cell collectionelicits strong post-transplant CD4+ and CD8+ responses which werepotentiated by additional vaccination given immediatelypost-transplant.³⁵

For myeloma patients, this concept has been tested by Rapoport et al.,who combined vaccination, adoptive T cell transfer, and high-dosechemotherapy and autologous hematopoietic stem cell transplantation forpatients with myeloma. In their studies, primed T cells were collectedafter immunization, expanded ex vivo with anti-CD3 and CD28 antibodiescoated beads, and re-infused just after high dose melphalan chemotherapyand ASCT. Vaccine boosts administered soon after the T cell transferlead to significantly higher antibody responses than vaccine boosts inpatients who had not had T cell transfer. T cell transfer resulted inaccelerated restoration of CD4 T cell function and allowed vaccinespecific immunity in just one month following autologous SCT.³⁶ In theirstudies, stem cells were collected from peripheral blood aftermobilization with cyclophosphamide, a treatment that yields few T cellsin the graft.

Rapoport reported that an HLA-A2 restricted combined peptidevaccination, consisting of the survivin Sur1M2 peptide (LMLGEFLKL) and 3hTERT peptides, could elicit an immune response in the context ofautologous transplant for myeloma. In that trial 28 myeloma patientswere vaccinated prior to collection of T cells by pheresis. These cellswere then stimulated and expanded ex vivo. Patients then had stem cellscollected from peripheral blood after mobilization withcyclophosphamide, a treatment that yields few T cells in the graft. Thevaccine primed and ex vivo expanded T cells were then re-introduced intothe patient during the lymphopenic period after high dose melphalanchemotherapy and transplant. Patients were then re-vaccinated aftertransplant to potentiate that immune response. Although patients werenot stratified by tumor associated antigen expression, it wasdemonstrated that adoptive transfer of vaccine-primed and co-stimulatedT cells increased cellular antitumor immune reconstitution, in thepost-transplant setting. Reactions to the peptide vaccines wereacceptable with reactions limited to muscle aches, redness, andinduration at the injection site.

Despite the effectiveness of this approach at safely eliciting immuneresponses against tumor, an approach which does not require ex vivo Tcell priming, expansion and manipulation might be preferable.Furthermore, a strategy which does not require a specific HLA type, andselects patients based upon survivin expression will maximize thepatients eligible for therapy while excluding those less likely tobenefit.³⁷

Example 9—a Unique Immunotransplant Vaccination Schedule Induces StrongHumoral and Cellular Immune Responses for Myeloma Patients

None of the previously mentioned human ASCT trials coupled immunizationjust before standard G-CSF primed unfractionated hematopoietic cellcollection with immunization again early post-transplant, during theperiod of homeostatic proliferation.

The inventors hypothesized that immune responses could be generated byvaccination and immunotransplant without ex vivo T cell expansion, suchas done by Rapoport. To test this, the inventors conducted a feasibilityand biological activity study of Prevnar-13 (PCV-13), a pneumococcal13-valent conjugate [diphtheria CRM197 protein] vaccination, beforeG-CSF mobilization and hematopoietic cell collection. Patients wereagain vaccinated during the lymphopenic period, 21 days aftertransplant. Biological endpoints of this study included antibodyresponses against pneumococcal serotypes and T cell responses againstCRM197.

Prevnar-13 was well tolerated. IgG against vaccine-specific serotypeswas significantly increased [Geometric mean IgG=0.45 (95% CI=0.33-0.66)pre- to 4.12 (95% CI=2.7-6.2) post-vaccine; p<0.001]. IgG againstpneumococcal serotypes not included in the vaccine did not increase(FIGS. 13A-13B). Six of 11 vaccine-specific serotypes IgG tested weresignificantly increased after transplant (p<0.05) (data not shown).

Vaccination met the primary endpoint by eliciting CD4+ and CD8+ celldivision and expression of intracellular IFN-gamma in response toCRM197, the Prevnar-13 adjuvant (p<0.05) (FIGS. 14A-14B). CD8+ cells hada significant increase of the cytotoxicity marker CD107a (p<0.05) (FIGS.14C-14D).

Prevnar-13 vaccination before and 21 days after autologous transplant issafe and elicits specific antibodies, CD4+ helper, and CD8+ cytotoxicresponses against pneumococcal serotypes and CRM197 adjuvant in myelomapatients. Vaccination against myeloma-associated antigens should betested before and 21 days after auto-transplant.

Thus, combination of high-dose chemotherapy with HCT and cancer vaccinesis feasible and may result in potent immune response.

For a vaccine to be efficacious, it must present tumor-specific antigenswhose presence is vital for the survival of the neoplastic cell and mustactivate immune responses and, if necessary, overcome the state ofimmune tolerance associated with cancer.³²

Human cancer cells express protein antigens that can be recognized by Tcells and are not expressed in normal tissues, thus providing potentialspecific targets for cancer immunotherapy. Dendritic cells (DC) are themost potent known antigen-presenting cells and are essential forinitiation of T cell mediated immunity; this property has prompted theirrecent application to therapeutic cancer vaccines. DCs expressco-stimulatory molecules such as CD40, CD80, and CD86, among others,that are essential to activation of primary cellular immune responses.In this trial the inventors will utilize monocytes-derived myeloiddendritic cells to present survivin.

Survivin is a highly attractive target for cancer immunotherapy becauseit is essential for cancer cell survival¹⁷ and drug resistance,^(12,13)and it is over-expressed by tumors but not most normal adult cell.Overexpression of survivin results in increased expression ofsurvivin-derived epitopes on the tumor cell surface. These epitopes inassociation with MHC class I molecules, represent targets for cytotoxicT cells (CTL). Previous studies have demonstrated the generation ofsurvivin-specific CTL responses in vitro in cancer patients and in vivoin tumor-bearing mice.^(38,39) One of the most effective methods togenerate potent survivin-specific responses is a vaccine that utilizesdendritic cells (DC) transduced with full-length mutant survivin⁴⁰. Theuse of mutant survivin eliminates the potential problem of delivering ananti-apoptotic activity associated with wild-type survivin to patients.The overexpression of full-length survivin in DCs allows for thepresentation of multiple different epitopes. Finally, the use of anadenovirus backbone provides for high efficiency of DC transduction, andresults in DC activation, two aspects that are crucial for the successof cancer immunotherapy.

Example 10—Immunotransplant Strategy for Vaccination Against Survivinfor Myeloma Patients

-   -   Survivin is an ideal myeloma tumor associated antigen        -   High survivin expression is linked to progressive and            refractory myeloma        -   Survivin is expressed in a significant proportion of our            patients        -   Myeloma patients have T cells against survivin    -   The full length double mutant survivin vaccine was developed        -   This vaccine leads to immune responses against tumors in            animal models        -   This vaccine leads to T cell responses against survivin in            myeloma patient samples, even when there are very few            survivin specific T cells        -   This removes the need for HLA matching required with peptide            based vaccines,        -   This allows for T cells specific for numerous epitopes to be            generated.        -   The mutated form of survivin decreases any potential for            toxicity without compromising immune responses

Numerous others have tested survivin peptide vaccines and survivinantagonists without significant toxicity, here the inventors will testthe safety and biological activity of their novel approach to targetsurvivin.

-   -   Novel schedule of vaccination and immunotransplant results in        robust immune responses using a pneumonia vaccine        -   Using the same schedule should result in robust immune            responses against survivin    -   Ex vivo manipulation of the transferred T cells is not required        and our strategy of G-CSF mobilized collection of both T cells        and hematopoietic stem cells allows for a more physiologic        development of T cells within the patient.        -   This is important as the repertoire of naive to central            memory to effector memory subsets is known to play a key            role in the efficacy following adoptive transfer

The inventors propose a novel strategy, combining the double mutantsurvivin-dendritic cell vaccine with high-dose-chemotherapy andautologous hematopoietic cell transplantation. Immunization of patientsprior to stem cell mobilization should result in accumulation ofsurvivin-specific T cells in vivo, that will be collected andtransferred as part of HCT.

The inventors propose that this strategy combined with post-HCTsurvivin-dendritic cell vaccination boost will be safe and induce immuneresponses against survivin in myeloma patients.

Example 11—Determination of Whether Immune Responses are Induced bySurvivin Vaccination in Patients with Myeloma Before and AfterAutologous HCT

To pursue this aim, MM patients with high survivin expression willreceive survivin vaccine prior to stem cell mobilization and collection,and again after autologous HCT. The hypothesize that immunization ofpatients to survivin before stem cell collection will prime T cellsagainst survivin, and allow for collection of those T cells along withthe stem cells. T cells that are infused with the graft will augment theimmune response against myeloma, exploiting the homeostatic repopulationprocess that occurs after high dose therapy. Immune response to survivinwill be measured by IFN-gamma ELISPOT and by limiting dilution precursorfrequency analysis (proliferation). The inventors will also evaluateimmune responses to other tumor-associated antigens and evaluate theimmune response after the start of lenalidomide post-transplantmaintenance therapy.

Survivin is undetectable in most adult tissues, except for low levelexpression in thymocytes, resting, activated and memory T cells,hematopoietic progenitor cells, and colonic epithelial cells. Otherinvestigators have safely immunized against survivin peptide sequencesin the setting of autologous transplant, however the inventors willmonitor for unforeseen toxicities in survivin-expressing tissues. Inthis aim the inventors will determine the full toxicity profile for fulllength dendritic cell based survivin vaccination in myeloma patients.The inventors will closely monitor time and persistence of hematopoieticengraftment, T cell reconstitution, toxicity in the gastrointestinalsystem, and any other organ toxicity. The inventors will conduct asingle arm feasibility study of 10 patients to evaluate clinicalefficacy of this intervention.

Inclusion Criteria for Screening Phase

Patients with histologically confirmed Multiple Myeloma (see AppendixIII) that are potentially eligible for high dose chemotherapy andautologous stem cell transplant in the future. Patients must have a bonemarrow biopsy available, or one scheduled to be performed for a clinicalindication. (Patients that have been treated with an induction regimenare eligible for this phase of study)

Inclusion Criteria for Treatment Phase

Patients enrolled in screening phase of studyPatients are planned for treatment with high dose melphalan andautologous HCT.

CBC with an absolute neutrophil count (ANC)≥1,000/uL, hemoglobin ≥8.0g/dL and platelet count ≥50,000/uL.

Liver enzymes: total bilirubin less than or equal to 2 mg/dL (>2 mg/dLpermitted if the patient has Gilbert's disease); AST and ALT less than1.5× the upper limit of normal.

Exclusion Criteria for Treatment Phase

Patients with CR or stringent CR after induction therapy as defined byInternational Response Criteria after most recent therapy.

Patients with progressive disease at time of transplant

Pregnant or lactating woman (as evaluated by serum testing within 48hours of administration of the first vaccine in women of child bearingpotential

HIV Infection Confirmed by NAT

Common variable immunodeficiency

Active CNS malignancy

Active bacterial, fungal or viral infection

Prior history of allogeneic hematopoietic cell transplantation

Prior malignancy within 5 years of enrollment excluding non-melanomaskin cancer or cervical carcinoma after curative resection, notrequiring chemotherapy.

History of severe allergy (e.g., anaphylaxis) to any component ofPrevnar or any diphtheria-toxoid containing vaccine

Enrollment Procedure

Patients will be identified as potential study candidates at initialdiagnosis, while receiving induction therapy, or at the time oftransplant consultation. Potential trial patients will be approached,provided an explanation of the trial, and given a copy of the informedconsent.

If the patient meets the criteria for the screening phase and decides toparticipate he/she will be asked to sign the informed consent documentand enrolled in the screening phase of the study. Next a bone marrowbiopsy specimen will be obtained (prior collected specimens, ifobtainable, are permitted) to determine survivin expression byimmunohistochemistry.

If the patient's marrow plasma cells express survivin, then thisinformation will be shared with them by the research team. Inclusioncriteria for the treatment phase will be reviewed before proceeding tothe treatment phase.

Treatment Plan

Patients will receive 1 pre-transplant survivin vaccine, 7-30 days priorto stem cell apheresis collection. A second survivin vaccine will beadministered on day +21 (between day +20 and +34) after HCT.

Generation of survivin vaccine

-   -   Mononuclear cells for the production of myeloid dendritic        cells (DC) will be obtained through a single apheresis procedure        and stored in liquid nitrogen at least 21 days after completion        of induction therapy. After collection through apheresis,        mononuclear cells will be cryopreserved. Just before patients        are due for vaccination, cells will be thawed and placed in        X-VIVO-15 medium (Biowhittaker, Walkersville, Md.) in tissue        culture flasks at a concentration of 1.3 to 1.7×10⁶ cells/mL.        After culturing for 2 hours, non-adherent cells will be removed        and the flasks will be recharged with X-VIVO-15 medium        supplemented with 5 ng/ml GM-CSF and 5 ng/ml of interleukin-4        (R&D systems, Minneapolis, Minn., USA) and incubated for 48        hours. Thereafter, additional cytokine-supplemented medium will        be added to the flasks and incubated for additional 72 hours. At        the completion of incubation, the non-adherent and loosely        adherent cells will be collected and used for a 2 hour infection        with Ad-survivin at an optimal ratio of 15,000:1 viral particle        to cell ratio. The optimal ratio to produce the highest level of        survivin expression with the least amount of toxicity to        dendritic cells was determined in preliminary experiments by our        group and on file with the FDA. At the end of the 2-hour        incubation, X-VIVO medium will be added to a final concentration        of 1×10⁶ cells/mL, and cells will be incubated in the flasks for        an additional 46 hours, at which time the cells will be        harvested, washed and analyzed.    -   Release Criteria: in order to release the vaccine for clinical        use several criteria must be met including:        -   A negative Gram's staining;        -   An endotoxin concentration no greater than 5 EU/ml;        -   A mature DC phenotype and evidence of intracellular survivin            expression by western blot or flow cytometry analysis.

Pre-Transplant Vaccination

-   -   At a time not greater than 30 days (and not less than 7 days)        from planned stem cell apheresis collection, vaccine will be        administered by intradermal injection at a site that drains to        the axillary and/or inguinal lymph node basins. Patients will        receive premedication with diphenhydramine. Acetaminophen may be        used also as pre-medication. Steroids as a pre-treatment should        be avoided.

Stem Cell Mobilization and Collection

-   -   Patients will undergo stem cell mobilization with G-CSF        (granulocyte colony-stimulating factor) per institutional        protocol. Plerixafor use is permitted and is at the discretion        of the treating physician. A minimum of 4×10⁶ CD34⁺ peripheral        blood stem cells per kilogram of recipient's body weight must be        collected prior to proceeding to autologous stem cell        transplant. All patients will have at least 2×10⁶ CD 34+ cells        stored after transplantation. The stem cells from autologous        patients will be cryopreserved and stored in Cell Core Facility        until the day of transplant.

Post-Transplant Vaccination

-   -   On or between day +20 to +34 after stem cell infusion the        post-transplant survivin-DC vaccine will be administered by        intradermal injection at separate sites that drain to the        axillary and inguinal lymph node basins. Patients will receive        premedication with diphenhydramine. Acetaminophen may be used        also as pre-medication. Steroids will be avoided.

Co-Immunization with 13-Valent Pneumococcal Conjugate Vaccine (PCV13,Prevnar13)

-   -   All patients will be co-immunized with Prevnar at each time they        receive the survivin vaccine. This vaccine will be administered        IM (0.5 cc). Since Prevnar is a T cell dependent vaccine for        Streptoccocus pneumonia, evaluation of anti-pneumococcal immune        response will serve as a positive control for a vaccine immune        response. In addition Prevnar includes the CRM protein as an        adjuvant and T cells responses against this adjuvant can be        tested directly.

Vaccination Administration

-   -   Deferral of vaccination until resolution of the offending event        will occur in the following instances:        -   Platelet count <20,000/microliter at the time of ID            injection (survivin vaccine), or <50,000/microliter at the            time of IM injection (Prevnar). These may be obtained with            platelet transfusions.        -   The patient is febrile.        -   The patient is septic or is on ventilatory or vasopressor            support.    -   Patient Monitoring for injection reaction: Vital signs will be        checked prior to administration of vaccine, and 60 minutes after        administration. 60 minutes after injection, the site will be        examined for local reaction.

Suspension of Treatment

-   -   Patients will be removed from the treatment phase of the study        for the following reasons (note that patients having already        received one or more vaccine will remain on the protocol for        safety evaluation):

Progressive Disease as Defined in Appendix I

-   -   Patients having serious anaphylactic/anaphylactoid reactions to        the vaccination.    -   Patients having any serious or life-threatening reactions to any        of the study treatments such that, in the opinion of the        investigators, continuation in the study is not in the best        interest of the patient    -   Patients unable to harvest sufficient monocyte dendritic cell        precursors to generate enough vaccines for 3 doses ability to        administer the vaccine due to microbial contamination or other        safety concerns    -   Non-compliance    -   Ineligibility for HCT    -   Failure to collect sufficient stem cells for HCT (at least 4        million/kg BW)

Clinical and Laboratory Evaluations

-   -   Survivin Immunohistochemistry.    -   The tissues will be stained for Survivin, using a rabbit        polyclonal antibody

(Novus Biologicals, Inc.), per institutional and manufacturers protocol.The specificity of the anti-Survivin polyclonal antibody will beconfirmed by using survivin overexpressing and survivin absent celllines or tissues. Negative controls will be included by omittingsurvivin antibody during the primary antibody incubation step.

Immunohistochemical Data Analysis.

The Survivin stained tissues will be examined by an expert pathologist(Dr. Coppola). The positive reaction of Survivin will be scored intofour grades, according to the intensity of the staining: 0, 1+, 2+, and3+. The percentages of Survivin positive cells will also be scored intofive categories: 0 (<5%), 1 (5-25%), 2 (26-50%), 3 (51-75%), and 4(76-100%). The product of the intensity by percentage scores will beused as the final score. A product score ≤1 will be considered negative.Survivin is expressed in about 40% of myeloma patients.

Initial Study Evaluation after Induction Therapy for MyelomaEligibility to proceed with high dose chemotherapy and autologous HCTwill be per institutional guidelines. This evaluation will be obtainedwithin 30 days of pheresis to collect PBMC, and will be conducted perMoffitt Institutional Guidelines.

-   Post-transplant evaluation at day +60 ((+/−15 days), day +90 (+/−15    days), and day +180 (+/−20 days)    -   Comprehensive history and physical examination (including        performance status, height, weight)    -   CBC with differential    -   Serum biochemical screening profile (to include BUN, Serum        creatinine, glucose, uric acid, sodium, potassium, total        calcium, magnesium, bilirubin, total protein, albumin, alkaline        phosphatase, AST, ALT, GGT, LDH).    -   SPEP, UPEP, Serum free light chains, Quantitative        Immunoglobulins    -   Bone marrow aspiration and biopsy with cytogenetics and myeloma        FISH panel (only if necessary to confirm complete remission)    -   Bone survey for patients with pre-transplant bony disease (to be        done at day +90 (+/−15 days))

Disease Status Evaluations

-   -   Disease status will be evaluated at day +90 (+/−15 days), day        +180 (+/−20 days), according to International Response Criteria    -   Pre and post vaccinations immune response evaluations    -   Immunologic responses will be measured at baseline prior to the        first vaccination, after stem cell mobilization and collection,        and post-transplant at day +60, +90, and +180. At each time 50        cc of peripheral blood will be collected from the patients in a        heparinized tube. Immune response evaluations will consist of        the following:        -   Analysis of Interferon-gamma producing T cells in ELISPOT            assays in response to the DC with survivin peptide pool. The            definition of a positive response will be a post-vaccination            result that is higher than the pre-vaccination values AND            values in cells stimulated with unloaded DCs by at least 2            times the standard deviation AND with a value of at least 10            spots per 100,000.        -   Measurement of anti-pneumoccocal IgG antibody titers and T            cell responses against CRM adjuvant will be done before the            first vaccine, and at day +60, +90, and +180 after            transplantation.        -   Determination of the survivin specific T cell frequency            using limiting dilution analysis and freely available online            software. Specifically the percentage of each patient's CD4+            and CD8+ T cells which are reactive against a survivin            peptide pool will be calculated at each time (baseline, day            +60, +90, and +180).        -   Evaluation of immunomodulatory phenotypes by T cell subsets            before and after vaccination. Patient PBMCs collected both            at baseline, at the time of stem cell collection (after            vaccination), and each follow-up will be stained and            evaluated by flow cytometry. PD-1 expression on T cells, and            PD-L1 expression in the tumor microenvironment, can predict            for response to immunomodulatory drugs such as anti-PD-L 1.            Peripheral blood CD4 and CD8 T cells and DCs, as well as            bone marrow aspirate collected before treatment, will be            stained for CD279+(PD-1); CD152+ (CTLA-4); and DCs for B7-H1            (PD-L1). A second experiment will test patient T cells            co-incubated with self-DCs+Ad-mS with or without blocking            antibodies against these targets (anti-PD1, anti-PD-L1, and            anti-CTLA-4). T cells will be separated after 7 days and            INF-gamma ELISPOT responses against survivin will determine            if promising targets might be pursued.

Determination of Safety.

-   -   Our approach for assessing potential toxicity of survivin        vaccination will focus predominantly on assessing hematopoietic        reconstitution, including T cell repopulation and        gastrointestinal toxicity. The inventors will also monitor for        autoimmune disorders involving other tissues where survivin        expression has been demonstrated: these include keratinocytes        and melanocytes, myocardium, liver, breast, and brain. It might        not be possible to assess toxicity on uterus, ovary, and testes        as these are compromised by high dose Melphalan and other        cytotoxic therapies for the myeloma.

Clinical Followup

-   -   Patients will follow up with a clinical trials coordinator        and/or physician to evaluate for any acute or sub-acute toxicity        according to standard of care. This includes daily assessment        until neutrophil engraftment. In the absence of any        complications, patients will then be followed as an outpatient        at day +60 (+/−15 days), and day +90 (+/−15 days) after        transplant, with the final determination of response at 6 months        made at +180 (+/−20 days) days after transplant.

Toxicity Scoring

-   -   Toxicity will be scored according to the NCI Common Toxicity        Criteria 4.0 (http://ctep.cancer.gov/reporting/ctc.html) grading        scale. Significant adverse events will only be scored if        unexpected with melphalan based autologous transplantation (see        section 7.3 and Appendix II). CTC toxicity will be assessed on        +60 ((+/−15 days), +90 (+/−15 days), day +180 (+/−20 days) and        results will be tabulated. Assessment of potential association        of toxicity with survivin vaccination will be possible if more        than one patient develops similar constellation of symptoms.

Hematopoietic Stem Cells.

-   -   Our data in mice and clinical data from others using survivin        antagonists or vaccines showed that targeting survivin did not        affect hematopoietic progenitor cells. The most sensitive test        to assess the potential toxicity of survivin vaccination on        hematopoietic function is the time of neutrophil repopulation        after HCT. Beginning on the day of HCT, patients will be        monitored daily for engraftment, that is defined by an absolute        neutrophil count of 500 cells per microliter that is sustained        for at least 3 days. The rate of failure of neutrophil        engraftment by day +21 in this population is estimated as <1%,        with the longest time to neutrophil engraftment in the last 100        patients treated at the Moffitt Cancer Center being 19 days.    -   After engraftment, the inventors will monitor absolute        neutrophils and platelet counts, and hemoglobin at least once        quarterly through one year, and assessment of hematological        toxicities will be done using the NCI Common Toxicity Criteria        3.0 grading scale.    -   In absence of cytotoxic therapy, grade 4 toxicity (graft loss)        would be unexpected. Thus, if one patient fails to engraft by        day +21, or experiences unexplained graft loss between day +21        and +180, the study will be suspended pending data review by the        Protocol Monitoring Committee (PMC) at the Moffitt Cancer        Center. Upon review, the PMC may re-activate the study, possibly        after protocol revision of the treatment plan or patient        eligibility criteria. If the study is re-activated, a second        failure to engraft or a second case of unexplained graft loss        will result in automatic termination of the study (see section        7.3 for stopping rules).    -   Any case with grade 4 hematopoietic toxicity would be evaluated        and treated with supportive therapy including antibiotics,        transfusions and growth factors if clinically indicated. Cases        meeting criteria for severe aplastic anemia would be treated as        such, employing state-of-the-art immune suppressive regimens. In        absence of recovery, reinfusion of cryopreserved autologous        cells would occur. For this purpose, all patients in the        treatment phase of study will be required to mobilize and        collect at least 4 million CD34+ cells/kg, thereby allowing to        store at least 2 million CD34+ cells in case a second stem cell        infusion is required.

T Cell Reconstitution

-   -   Since survivin is expressed in thymocytes and replicating T        cells, the inventors will monitor T cell reconstitution after        transplant by measuring CD4+ and CD8+ T cells on +90 (+/−15        days) and day +180 (+/−20 days) after transplantation in all        patients who received survivin vaccine. As there are no        definitive published control data after autologous        transplantation for myeloma, the results will be tabulated.    -   Grade 4 CTC defined toxicity for CD4 lymphopenia, i.e. below 50        cells per microliter at either time point would be unexpected        and considered as a possible toxicity, taking into account any        post-transplant therapy outside the scope of this trial, which        may have occurred.    -   Patients will receive appropriate antibiotic prophylaxis for        opportunistic infections, as recommended by the CDC at time of        study. The inventors will record the rate of infections in the        first year after transplant, with this data being collected at        the time of quarterly post transplant follow-up.

Reporting Serious/Unexpected Adverse Events: Definitions

-   -   Serious adverse events (SAE): are defined as those that are        fatal, life threatening require inpatient hospitalization or        prolongation of existing hospitalization, results in persistent        or significant disability/incapacity, or is a congenital        anomaly/birth defect. SAEs will be identified by the        investigators or BMT study coordinator and will be reported to        the IRB and PMC according to current institutional policy.    -   Based upon published data for the melphalan conditioning regimen        without vaccination⁴¹, the following toxicities occur at a high        rate which should be taken into consideration when reporting        SAEs (incidence of grade 3-4 in parenthesis):        -   Any hematologic toxicity (>77%)        -   The use of intravenous antibiotics (41%)        -   Mucositis (17%)        -   Diarrhea (5%)        -   Nausea or vomiting (6%)        -   Infection (40%)        -   Hospitalization after engraftment (48%)    -   Unexpected adverse events: include those events not identified        in their nature, severity, or frequency in the published blood        and marrow transplant literature or those not included in the        “Risks” section of the informed consent. These events will be        identified by the investigators or BMT Research Staff and will        be reported to the IRB and PMC according to current policy.    -   Exceptions        -   Exceptions to the reporting will be the following commonly            anticipated events:        -   Hospitalizations post mobilization or post transplant for            neutropenic or non-neutropenic fevers        -   Hospitalizations for non-life-threatening events        -   Hospitalizations for chemotherapy or radiation therapy (or            its complications) used for the treatment of progressive            disease        -   Extended outpatient (EOP) admissions or 23 hour observation            admissions        -   Relapse-related deaths        -   Hospitalizations after relapse of primary disease

Statistical Considerations

Primary Endpoint and Sample Size Determination

Screening Phase of Study

-   -   Consenting patients with MM will be screened for survivin        expression in myeloma cells by IHC of a bone marrow biopsy        performed at any time. All cases will be reviewed and scored for        MM survivin expression using the Allred score.⁴²        Survivin-positive patients (Allred score >=2) are eligible, and        our preliminary data indicate this accounts for about 40% of        patients at the time of AHCT (18/48 patients, data not shown).        Only patients that failed to achieve a CR prior to transplant        are eligible. Otherwise standard institutional criteria for        autologous transplant will serve as eligibility criteria.        Conservatively, the inventors anticipate the need to screen 100        patients of which 40 would be survivin positive and 10 (25%)        would be eligible and consent to treatment. The inventors        perform about 140 AHCT/year for MM, 70 (50%) of which are in CR        at transplant, so the inventors should be able to screen 100        patients in ˜1.5 years. Accrual and completion of treatment        (n=10) is expected in 2.5 years

Biological Endpoint and Treatment Phase Sample Size Determination

-   -   The inventors propose this treatment will increase the frequency        (%) of circulating survivin reactive CD4+ T cells (see        Interpretation of immune response). Comparison of the        pre-vaccine frequency to the post-transplant (day +60) frequency        will serve as the primary endpoint.    -   The inventors hypothesize that survivin vaccination will        increase the survivin reactive CD4+ cell frequency at day +60        compared to baseline in greater than 55% of patients. If the        true response rate is <=20%, the inventors will conclude that        this approach is ineffective at generating T cell responses with        a probability of at least 90% (alpha=0.10). If the true response        rate is >=55%, the inventors will conclude that the therapy is        effective at generating T cell responses with a probability of        at least 90% (beta=0.90). To reject the null hypothesis, that        the response rate <=20%, the inventors will need at least 4        (of 10) patients to mount an effective IFN-gamma ELISPOT        response over baseline.

This Design has the Following Two Properties:

-   -   The choice of a one-sided study with alpha=0.10 is quite common        in early phase trials, as it increases the probability of not        missing a potentially useful therapy. The choice of beta=0.10 is        frequently recommended by CTEP statisticians, as it increases        the probability that potentially useful therapies will not be        deemed ineffective.

Expected Length of the Study

-   -   Approximately 140 autologous transplants for myeloma are        conducted at Moffitt Cancer Center per year. The inventors        estimate that 42 patients per year (30%) will agree to        participate in the screening phase. To enroll the anticipated 63        patients to the screening phase the inventors estimate it will        take 18 months. Including the 6 month followup the inventors        anticipate the length of time it will take to complete the study        will be 2 years.

Stopping Rules for Toxicities (Safety)

-   -   The most sensitive test to assess the potential toxicity of        survivin vaccination on hematopoietic function is the time of        neutrophil repopulation after ASCT. Beginning on the day of        ASCT, patients will be monitored daily for engraftment, which is        defined by an absolute neutrophil count of 500 cells per        microliter that is sustained for at least 3 days. The rate of        failure of neutrophil engraftment by day +21 in this population        is estimated as <1%, with the longest time to neutrophil        engraftment in the last 100 patients treated at the Moffitt        Cancer Center being 19 days. Thus, if one patient fails to        engraft by day +21, or experience unexplained graft loss between        day +21 and +180, the study will be suspended pending data        review.    -   The inventors will also perform CD34 viability assays in the        cells harvested for transplantation prior to starting high dose        chemotherapy. Assessment of potential association of toxicity        with survivin vaccination will be possible if more than one        patient develops similar constellation of symptoms. Careful        assessment and monitoring of other toxicities will be done using        the NCI Common Toxicity Criteria 4.0        (http://ctep.cancer.gov/reporting/ctc.html) grading scale.

Data Management:

-   -   Data related to the immunologic parameters such as doses of        vaccination, clinical and immunologic responses to vaccination        will be entered into the immunology database at the H. Lee        Moffitt Cancer Center and will also be kept confidential. In        computer-generated reports for external review, patients will        only be referred to by a unique identification number. The BMT        and immunology research databases are password protected and        limited only to designated personnel.    -   Representatives of the USF IRB, the FDA, and other governmental        regulatory authorities will have access to patient information        as it pertains to the study. Privacy and confidentiality of the        information will be protected to the extent provided by law.

Ethical and Regulatory Considerations

-   -   Informed consent: all patients will be required to sign a        statement of informed consent that has been approved by the        local Institutional Review Board. The principal investigator or        designated co-investigator (during absence of PI) is responsible        for verifying compliance with all aspects of both the protocol        and the informed consent process, which must indicate that the        patient has received adequate information to make such informed        consent.    -   Women and minorities: The inventors will assure that the        participation of women and minority subjects will reflect the        percentage representation of these populations in our region.        This study will not discriminate against any subgroup of        patients. All eligible patients will be offered participation in        this study.

Data and Safety Monitoring Plan

The principal investigator will have the primary responsibility for datasafety and monitoring. Input will be sought from sub investigators andother members of the BMT and Thoracic Oncology Program concerning dataand safety issues. The Moffitt Cancer Center Protocol MonitoringCommittee (PMC) will provide oversight for monitoring. The PMC meetsmonthly and reviews accrual, patterns and frequencies of severe orunexpected adverse events as defined in the protocol, protocolviolations and, when applicable, internal audit results.

References for Examples 6-11

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Casati C, Dalerba P, Rivoltini L, et al. The apoptosis inhibitor    protein survivin induces tumor-specific CD8+ and CD4+ T cells in    colorectal cancer patients. Cancer Res 2003; 63:4507-15.-   40. Pisarev V, Yu B, Salup R, Sherman S, Altieri D C, Gabrilovich    D I. Full-length dominant-negative survivin for cancer    immunotherapy. Clin Cancer Res 2003; 9:6523-33.-   41. Palumbo A, Bringhen S, Bruno B, et al. Melphalan 200 mg/m(2)    versus melphalan 100 mg/m(2) in newly diagnosed myeloma patients: a    prospective, multicenter phase 3 study. Blood 2010; 115:1873-9.-   42. Allred D C, Harvey J M, Berardo M, Clark G M. Prognostic and    predictive factors in breast cancer by immunohistochemical analysis.    Mod Pathol 1998; 11:155-68.

APPENDIX I International Uniform Response Criteria for Multiple Myeloma(IWG) (Leukemia (2006) 20: 1467-1473) Summary Table Response SubcategoryResponse Criteria sCR CR as defined below plus normal FLC ratio andabsence of clonal cells in bone marrow by immunohistochemistry orimmunofluorescence¹ CR Negative immunofixation on the serum and urine,disappearance of any soft tissue plasmacytomas, and ≤5% plasma cells inbone marrow VGPR Serum and urine M-protein detectable by immunofixationbut not on electrophoresis or 90% or greater reduction in serumM-protein with urine M-protein level <100 mg per 24 hours PR ≥50%reduction of serum M-protein and reduction in 24 hour urinary M- proteinby ≥90% or to <200 mg per 24 hours If the serum and urine M-protein areimmeasurable, a ≥50% decrease in the difference between involved anduninvolved FLC levels is required in place of the M-protein criteria. Ifserum and urine M-protein and serum FLC are immeasurable², then ≥50%reduction in plasma cells is required in place of M-protein, providedbaseline bone marrow plasma cell percentage was ≥30% In addition to theabove listed criteria, if present at baseline, a ≥50% reduction in thesize of soft tissue plasmacytomas is also required SD Not meetingcriteria for CR, VGPR, PR, MR or PD PD Progressive Disease requires anyone or more of the following: Increase of ≥25% from baseline in: serumM-component and/or (the absolute increase must be ≥0.5 g/dL) urineM-component and/or (the absolute increase must be ≥200 mg/24 h) Only insubjects without measurable serum and urine M-protein levels: thedifference between involved and uninvolved FLC levels. The absoluteincrease must be >10 mg/dL. Bone marrow plasma cell percentage: theabsolute % must be ≥10% Definite development of new bone lesions or softtissue plasmacytomas or definite increase in the size of existing bonelesions or soft tissue plasmacytomas Development of hypercalcemia(corrected serum calcium >11.5 mg/dL or 2.65 mmol/L) that can beattributed solely to the plasma cell proliferative disorder Footnotes:¹Presence/absence of clonal cells is based upon the κ/λ ratio. Anabnormal κ/λ ratio by immunohistochemistry and/or immunofluorescencerequires a minimum of 100 plasma cells for analysis. An abnormal ratioreflecting presence of an abnormal clone is κ/λ of >4:1 or <1:2.²Measurable disease: serum M protein >1 g/dL, urine M-protein >200 mg/24hr, or serum involved FLC levels >10 mg/dL with a normal κ/λ ratio.FreeLite ™ Disease Response Criteria CR: For those patients beingfollowed by serum free light chain (and NO measurable serum or urineM-spike), which were immunofixation negative at enrollment,normalization of serum free light chain ratio. PR: If only measurableparameter is serum immunoglobulins free light chain (FLC), EITHER of thefollowing changes quality as partial response: A 50% decrease in thedifference between involved and uninvolved FLC levels; OR A 50% decreasein the level of involved FLC AND a 50% decrease (or normalization) inthe ratio of involved/uninvolved FLC MR: 25-49% reduction in the levelof the serum monoclonal paraprotein. Patients being followed by serumimmunoglobulins free light chain only will not be assessed for MRcategory. PD: If only measurable parameter is serum immunoglobulins freelight (FLC), either of the following qualify as progression: 50%increase in the difference between involved and uninvolved FLC levelsfrom the lowest response level, which must also be an absolute increaseof at least 10 mg/dL; OR 50% increase in the level of involved FLC AND a50% increase in the ratio of involved/uninvolved FLC from the lowestresponse level.

APPENDIX II Common and expected toxicity associated with high dosemelphalan and autologous transplant (From Palumbo et al. ⁴¹) Grade 3/4adverse events MEL200 (N = 149), no. (%) Hematologic Grade 4neutropenia, no. (%) 114 (77)  Grade 4 neutropenia duration, d Median 6Range 0-15 Grade 4 thrombocytopenia, no. (%) 113 (76)  Grade 4thrombocytopenia duration, d Median 1 Range 0-20 Red cell transfusion,no. (%) 43 (29) Platelet transfusion, no. (%) 82 (56) Hospitalizationafter engraftment No. of patients (%) 100 (68)  Median, d 3 Range, d1-25 Intravenous antibiotics No. of patients (%) 60 (41) Median, d 7Range, d 2-28 Nonhematologic Mucositis, no. (%) 26 (17)Gastrointestinal, no. (%) 16 (11) Diarrhea 7 Vomiting 9 Infection, no.(%) 60 (40) Neutropenic fever 26  Pneumonia 11  Sepsis 14  Centralvenous catheter 2 Viral 4 Other 3 Thromboembolism, no. (%) 3 (2) Deepvein thrombosis 1 Pulmonary embolism 2 Renal, no. (%) 1 (1) Cardiac, no.(%) 1 (1) Pulmonary, no. (%) 1 (1) Neurologic, no. (%) 1 (1) Bleeding,no. (%) 1 (1) Coagulation, no. (%) 0 (0) At least 1 event, no. (%) 67(45)

Appendix III: Criteria for Diagnosis of Multiple Myeloma & ClinicalMyeloma Staging System

Patients are eligible for the trial if they meet the criteria fordiagnosis per the major and minor criteria, or the criteria forsymptomatic myeloma.

Criteria for Diagnosis of Multiple Myeloma Major Criteria:

-   1. Plasmacytomas on tissue biopsy-   2. Bone marrow plasmacytosis (>30% plasma cells)-   3. Monoclonal Immunoglobulin spike on serum electrophoresis:    IgG >3.5 g/dL or IgA >2.0 g/dL; kappa or lambda light chain    excretion >1.0 g/day on 24-hour urine protein electrophoresis

Minor Criteria:

a. Bone marrow plasmacytosis (>10-30% plasma cells)

b. Monoclonal Immunoglobulin spike present, but of lesser magnitude thangiven above

c. Lytic bone lesions

d. Normal IgM <50 mg/dL, IgA <100 mg/dL, or IgG <600 mg/dL

Any of the Following Sets of Criteria Will Confirm the Diagnosis:

Any two major criteria

Major criterion 1 plus minor criterion b, c or d

Major criterion 3 plus minor criterion a or c

Minor criteria a, b and c or a, b and d

Symptomatic Multiple Myeloma²⁹

Symptomatic multiple myeloma requires the presence of related organ ortissue impairment (end organ damage, including bone lesions) describedbelow:

1—Hypercalcemia is defined as serum calcium ≥11 mg/dL (2.75 mmol/L)

2—Renal insufficiency is defined as a serum creatinine ≥2 mg/dL (173mmol/L)

3—Anemia is defined as a hemoglobin concentration ≤10 g/dL

4—Lytic lesions on skeletal survey or other imaging modality (MRI/CT)

5—Biopsy confirmed amyloidosis

Appendix V: Survivin Expression by Immunohistochemistry

The tissues will be stained for Survivin, using a rabbit polyclonalantibody (Novus Bgicals, Inc.). The slides will be dewaxed by heating at55° C. for 30 minutes and by three washes, five minutes each, withxylene. Tissues will be rehydrated by a series of five-minute washes in100%, 95%, and 80% ethanol, and distilled water. Endogenous peroxidaseactivity will be blocked with 3% hydrogen peroxide for 20 minutes. Afterblocking with universal blocking serum (Ventana Medical Systems, Inc.,Tucson, Ariz.) for 30 minutes, the samples will be incubated withanti-Survivin rabbit polyclonal antibody (dilution 1:8000) at 4° C.overnight. The samples will then be incubated with biotin-labeledsecondary antibody and streptavidin-horseradish peroxidase for 30minutes each (Ventana Medical Systems). The slides will be developedwith 3,3′-diaminobenzidine tetrahydrochloride substrate (Ventana MedicalSystems Inc.) and counterstained with hematoxylin (Ventana MedicalSystems Inc. Tucson, Ariz.). The tissue samples will be dehydrated andcoversliped. Standard cell conditioning (following the Ventanaproprietarian recommendations) was used for antigen retrieval. Thespecificity of the anti-Survivin polyclonal antibody will be confirmedby using survivin overexpressing and Survivin KO cell lines. Negativecontrol will be included by omitting Survivin antibody during theprimary antibody incubation step.

Immunohistochemical data analysis. The Survivin stained tissues will beexamined by an expert pathologist (DC). The positive reaction ofSurvivin will be scored into four grades, according to the intensity ofthe staining: 0, 1+, 2+, and 3+. The percentages of Survivin positivecells will also be scored into five categories: 0 (<5%), 1 (5-25%), 2(26-50%), 3 (51-75%), and 4 (76-100%). The product of the intensity bypercentage scores will be used as the final score. A product score <1will be considered negative.

APPENDIX VI Follow up schedule Toxicity Case IWG Day after PhysicalLaboratory Vaccine Report response Event transplant* History ExamParameters Injection Form assessment First day, dendritic cell day −42 XX X collection apheresis Vaccine #1 day −35 X X X X X First day, stemcell day −14 X X X X collection apheresis Vaccine #32 day +7 X X X X XVaccine #43 day +21 X X X X X Immune response day +60 X X X X evaluation1 Immune response day +90 X X X X X evaluation 2 Immune response day+180 X X X X X evaluation 3 *The day in relation to transplant issuggested. These evaluations will occur at a time consistent with thatdescribed in the protocol for each event. For the referenced dates, awindow of time compared to transplant will be acceptable as follows: +60(+/−15 days) +90 (+/−15 days) +180 (+/−20 days) Note: Physical exam mustinclude lymph node examination and site of the injections.

Example 12—Safety and Biological Activity of Survivin Dendritic CellVaccine

The experiments of Example 12 were designed to test the safety andbiological activity of a survivin dendritic cell vaccine. A sample sizeof 10 patients with Multiple Myeloma will establish the feasibility ofthe approach, and allow for evaluation of the expected increased T cellresponse against survivin. Vaccine will be administered in two stages.After the first survivin vaccination, patients will be mobilized withG-CSF and both in vivo-primed T cells and stem cells will be collectedin the same apheresis (the graft). T cells and the CD34 progenitor cellswill be transferred back to the patient at the time of autologous graftinfusion. Patients will receive re-vaccination on day 21 aftertransplant. The immune response to survivin will be assessed for 6months and compared to the pre-vaccine response. To validate thepatient's ability to mount an immune response the inventors willsimultaneously vaccinate against PREVNAR13®, a pneumococcus vaccine ableto elicit T cell immune responses. Immunologic responses will bemeasured at baseline, after stem cell mobilization/collection, 60 days,90 days and 180 days after transplant. Peripheral blood mononuclearclles (PBMCs) will be isolated and stored in liquid N2. G-CSF cellmobilization, mononuclear cell collection, melphalan chemotherapy, andtransplant infusion will all be per institutional standards.

Primary objectives for these experiments include: (1) determining thesafety of an autologous dendritic cell (DC) adenovirus (Ad) vaccineexpressing the mutant protein survivin (mS) (DC:AdmS) when administeredto patients with myeloma before and at day +21 after autologoushematopoietic stem cell transplant; and (2) evaluating the ability ofDC:AdmS to induce T cell immune responses against survivin whenadministered to patients with myeloma before and at day +21 afterautologous hematopoietic stem cell transplant. Secondary objectives forthese experiments include: (1) determining the ability of a survivinpeptide pool to elicit T cell IFN-gamma production (ELISPOT, flowcytometry) or proliferation; (2) evaluating immunomodulatory phenotypesof T cell subsets before and after vaccination using flow cytometry; (3)determining the clinical response of treated patients and compare tohistorical controls; (4) evaluating immune responses to othertumor-associated antigens before and after vaccine; and (5) determiningT cell responses against PREVNAR13® (pneumococcal 13-valent) vaccineconcurrently administered at the time of survivin vaccine.

The 36 kD adenoviral (pAd) vectors, pAdTrack-CMV and pAdEasy-1 vectors,for homologous recombination in bacteria were kindly provided by B.Vogelstein (Johns Hopkins University School of Medicine, Baltimore, Md.,USA) and have been described (Mesri et al., 2001; Luo et al., 2007). ThecDNAs for Thr34→Ala survivin mutant (T34A) containing 5′ HindIII and 3′XbaI sites were inserted in pAdTrack downstream of the cytomegalovirus(CMV) promoter (FIG. 16A) to generate pAd-WT or pAd-T34A. Each shuttlevector was linearized with PmeI, electroporated in Escherichia coliBJ5183, and colonies were selected in 50 μg/ml of kanamycin. Each pAdconstruct (4-10 μg) was digested with PacI, transfected in 293 cells byLipofectamine (Life Technologies Inc., Rockville, Md., USA), andcultures were monitored for expression of green fluorescent protein(GFP), by fluorescence microscopy. The cell pellets were suspended in 1ml PBS, pH 7.4, and after three cycles of freezing and thawing, 1 ml ofviral lysate supernatant was used to infect 3-5×10⁶ 293 cells. Viruseswere harvested at 2-3-day intervals. To generate high-titer viralstocks, this process was repeated 3-5 times with a total of 5×10⁸packaging cells, and viral particles were purified by CsCl banding.Green fluorescence forming units (GFU) were estimated by serial dilutionof the virus stock in transduced 293 cells. To detect a potentialcontamination of viral stocks with replication-competent adenoviralparticles, HeLa cells (8×10⁴) in C-6-well plates were infected withpAd-GFP or pAd-T34A at moi of 1,250 for 8 hours and grown for 3 days at37° C. Cell extracts were prepared by freezing and thawing andsupernatants were used to successively infect a second culture of HeLacells, which was analyzed for viral transduction by GFP expression afteran additional 2-day interval at 37° C. Expression of survivin protein intransduced cultures was determined by Western blot analysis, using an Abto full-length recombinant survivin (NOVUS Biologicals Inc., Littleton,Colo., USA). FIGS. 16A-D depict construction and expression of singlemutant (T34A) pAd-survivin vectors.

Materials and Methods

Dendritic Cells (Monocyte-Derived Myeloid Dendritic Cells).

The target cells for this study are autologous dendritic cells fromperipheral blood, grown in an ex vivo culture system. As a consequenceof the growth conditions, the viral vector will primarily have access todendritic cells, reducing the amount of simultaneous infection of othercell types. Other cell types that are infected are all of similarderivation to the dendritic cells, and may in fact increase theimmunogenicity of the final gene transferred product.

Cell Collection Method.

The method of collection will be apheresis (unmobilized). Patients whoare enrolled in this study will have a single leukopheresis procedureperformed at the Moffitt Apheresis Facility. Approximately four bloodvolumes will be processed using the Terumo Spectra Optia® ApheresisSystem. Leukopheresis products will be delivered to the Cell TherapyFacility for further processing.

Donor Screening.

Donor screening will be performed according to 21 CFR Part 1271“Eligibility Determination for Donors of Human Cells, Tissues andCellular and Tissue-Based Products (HCT/Ps)”. All autologous donorsreceive a complete medical/surgical history and physical. In addition,all autologous donors complete a Donor Health History ScreeningQuestionnaire.

Tabulation of Testing.

Autologous donors are tested for the following infectious diseasemarkers (IDMs):

HIV 1/2 Ab (donor)

Hepatitis B surface Ag (donor)

Hepatitis B Core Ab (donor)

Hepatitis C Ab (donor)

HIV/HCV/HBV NAT (donor)

RPR for Treponema pallidum (syphilis)

HTLV-I/II Ab screen (donor)

CMV IgG/IgM (donor)

Varicella zoster IgG/IgM

HSV IgG ½

Chagas

Autologous donors are tested for the following additional labs:Sickle cell screen to assess for hemoglobinopathiesBeta HCG for females of child bearing age

Product Manufacturing—Procedures.

Frozen ficolled mononuclear cells (MNC) are thawed and enriched formonocytes through plastic adherence. The monocyte enriched population ofcells is cultured in the presence of GM-CSF and IL-4 for 5-6 days toinduce differentiation into dendritic cells (DC). DC are harvested andinfected with Ad-mSurvivin. Infected cells are cultured for anadditional 2 days and harvested for patient vaccination. The target doseis 10×10⁶ mSurvivin⁺ DC per vaccine with a maximum of 15×10⁶ cells pervaccine.

Preparations of Autologous or Allogeneic Cells.

A freshly collected leukopheresis product will be subjected to densitygradient separation with Ficoll-Paque PLUS using the HAEMONETICS® CELLSAVER® 5 Blood Recovery System. The CELL SAVER® 5 is a semi-automated,closed system using centrifugation and density gradient media toseparate blood components into plasma, mononuclear cells (MNC) and redblood cells (RBC). The mononuclear cell fraction will be harvested andcryopreserved in 10% DMSO/2.5% human serum albumin at a concentration of3×10⁸ cells/mL. Cryopreserved cells will be stored in the vapor phase ofliquid nitrogen (−190° C.) until needed for vaccine production. A flowchart showing processes for preparation of MNCs and apheresis forcryopreservation is shown in FIG. 17.

Just prior to vaccination, frozen mononuclear cells will be thawed,washed and placed in CELLGRO® DC culture medium in tissue culture flasksat a concentration of 1-2×10⁶ cells/ml. After culturing for 2 hours,non-adherent cells will be removed and the flasks will be recharged withculture medium supplemented with 5 ng/ml each of GM-CSF and IL-4 andincubated for 5 days. At the completion of incubation, the non-adherentand loosely adherent cells will be collected and used for a 2-3 hourinfection with Ad-mS at an optimal Multiplicity of Infection (MOI) of1000. At the end of the 2-hour incubation, culture medium will be addedto a final concentration of 1×10⁶ cells/ml, and cells will be incubatedin flasks for an additional 40-46 hours, at which time cells will beharvested, washed and analyzed. FIGS. 18-20 are flow charts showingprocesses for thawing and culturing during dendritic cell production(FIG. 18), harvest and Ad-mS infection of dendritic cells (FIG. 19), andharvesting of Ad-mS infected dendritic cells for infusion (FIG. 20).

Final Formulation:

Formulation/Infusion Buffer: PlasmaLyte-A with 1% HSAExcipients: PlasmaLyte-A with 1% HSACell Density/Concentration in the Final Product: 5-15×10⁶/ml

Storage Method Prior to Use: 2-8° C. Tabulation of Tests, ManufacturingStep, Test Methods, Criteria, and Test Sensitivity & Specificity

Manufacturing Step where Test Performed Method Criteria SensitivitySpecificity Sterility Pre-ficoll, pre- BacT/ALERT ® Negativecryopreservation, Aerobic and thawing, pre- Anaerobic System infection,final product Mycoplasma During final Venor ™GeM Negative 2-5 N/Acollection of cells Mycoplasma mycoplasma from culture Detection Kit persample volume Purity Final product Endosafe ®-PTS ™ <5.0 EU/kg 0.005-10(endotoxin) body weight EU/ml per hour Purity Immediately prior BDFACSCanto ™ ≥30% survivin+, N/A N/A (other to final formulation II flowcytometry CD11c+, HLA-DR+ contaminants) Identity Immediately prior BDFACSCanto ™ ≥30% survivin+, N/A N/A to final formulation II flowcytometry CD11c+, HLA-DR+ Potency Immediately prior BD FACSCanto ™ ≥30%survivin+, N/A N/A to final formulation II flow cytometry CD11c+,HLA-DR+ Others Pre-ficoll, pre- KX-21N N/A N/A N/A (cell counts)cryopreservation, Hematology pre-plastic Analyzer Sysmex adherence CellCounter Others Final product Acridine >70% N/A N/A (cell viability)Orange/Propidium Iodine staining by Cellometer

Test Methods.

Sterility Testing (Bacterial and Fungal Testing): Required suitablesterility tests include the test described in 21 CFR 610.12 and theUnited States Pharmacopoeia (USP) <71> Sterility Tests (23^(rd) edition,1995). Current FDA Guidance recommends that automated sterility testingprocedures are acceptable if they have been validated againstestablished methods. Our facility has successfully validated BacT/ALERT®3D (bioMérieux, Inc., Durham, N.C.) for detecting the presence orabsence of microorganisms, using a 14-day incubation period, and thistesting method has been used for all FDA-approved INDs at ourinstitution.

Mycoplasma Testing.

Mycoplasma testing will be performed in-house on the product afterculture at harvest but prior to cell washing. Testing will be conductedon both cells and supernatant by use of the Venor™ GeM MycoplasmaDetection Kit.

Purity: Pyrogenicity/Endotoxin Testing.

The Limulus Amebocyte Lysate test method (LAL), Endosafe®-PTS™ (CharlesRiver Laboratories), will be used as a pyrogenicity test to detectendotoxin. The upper limit of acceptance criterion for endotoxinadministered intravenously will be <5 EU/kg body weight/hour.

Purity: Other Cell Contaminants.

Analysis of DC immunophenotypes will be determined from cells using thefollowing fluorescence-conjugated (FITC, PE or PerCP) mouse anti-humanmonoclonal antibodies: intracellular survivin, cell surface markersrelated to lineage (CD3, CD14, CD20, CD56) and MHC class II (HLA-DR).Appropriate isotype controls will be set up in parallel. The cells willbe incubated for 20 minutes at room temperature and washed inphosphate-buffered saline (PBS) containing 0.5% bovine serum albumin. Aminimum number of 20,000 events will be collected on a BD FACSCanto™ IIflow cytometer using Diva v6.1.2 and Clinical v2.4 software for dataacquisition and analysis. Cells that are survivin expressing dendriticcells (survivin+, CD11c+, HLA-DR+); survivin non-expressing dendriticcells (survivin-, CD11c+, HLA-DR+), and survivin producing andnon-producing non-dendritic cells (survivin+/−, lineage+, HLA-DR+/−)will be enumerated. Pre-clinical studies have shown that approximatelyone third of the cells harvested express survivin. There is no knownmechanism whereby the remaining cells may have a deleterious effect onthe recipient.

Purity: Other Residual Contaminants.

It is anticipated that extensive washing with Harvest Medium(PlasmaLyte-A with 1% HSA) will remove (via dilution, centrifugation anddiscarding) residual proteins, viral vector and cytokines from the finalinfusion product. Cells will be washed free of residual culture mediaprior to infusion. Therefore, only trace amounts of residual reagentswill be present in the final product.

Identity and Potency: Presence of Viral Vector.

The ex vivo genetically modified DC cell product, will be tested by flowcytometry to measure the presence of intracellular survivn+, CD11c+ andHLA-Dr+, which represent the target cells.

Cell Counts & Viability.

Final Cell Counts and Viability will be performed on the Cellometer®Vision using AO/PI. The lower acceptable limit for viability is 70%.

Final Product Release Criteria/Specifications Tabulation of FinalProduct Release Criteria Tests, Test Methods, Criteria, Test Sensitivity& Specificity

Results Available Prior to Test Method Criteria Release BacteriologicBacT/ALERT ® Aerobic Negative No sterility and Anaerobic System GramStain Facility SOP# CTF-VI-006 No organisms Yes seen MycoplasmaVenor ™GeM Mycoplasma Negative Yes Detection Kit EndotoxinEndosafe ®-PTS ™ <5.0 EU/kg body Yes weight per hour Viability AO/PIStaining by >70% viable Yes Cellometer ® Vision Cell Dose KX-21NHematology 5-15 × 10⁶/ml Yes Analyzer Sysmex Cell Counter Cell BDFACSCanto ™ II flow ≥30% survivin+, Yes Phenotype cytometer CD11c+,HLA-DR+

Description of Test Methods

Sterility Testing (Bacterial and Fungal Testing).

As described previously

Gram Stain.

Sterility testing results will not be available prior to infusion. Underthese circumstances, a rapid microbial detection test, Gram stain, willbe performed. Release criteria for sterility will be based on a negativeresult of the Gram stain. Should sterility testing results from theBacT/Alert® 3D method test positive, the principle investigator and INDholder will be notified. A positive result will provide information forthe medical management of the subject, and trigger an investigation ofthe cause of the sterility failure. The sterility culture on the finalformulated product will be continued to obtain the full 14-day sterilitytest result even after the product has been given to the patient. In allcases where product release is prior to obtaining results from a full14-day sterility test, the investigational plan will address the actionsto be taken in the event that the 14 day sterility test is determined tobe positive after the product is administered to a subject.

Mycoplasma Testing.

As described previously

Purity: Pyrogenicity/Endotoxin Testing.

As described previously.

Viability.

As described previously

Cell Dose.

As described previously

Cell Phenotype.

Identity and Potency: As described previously.

Product Stability.

Stability testing will be performed to establish that the product issufficiently stable for the time period required by the study. Stabilitytesting will be performed according to “Quality of BiotechnologicalProducts: Stability Testing of Biotechnological/Biological Products,”ICH Guideline Q1A(R): “Stability Testing of New Drugs and Products”. Theinventors have developed the stability protocol and data for bothin-process material and the final product. Data will include a measureof product sterility, identity, purity, quality, and potency. Samplingtime points (including a zero-time point) and testing temperature willbe determined to assign a six hour duration of storage (expiration) at2-8° C. It will be demonstrated that the product is stable between thetime of final product formulation and infusion to subjects to aid inestablishing the expiration-dating period.

Cryopreserved Cells: NA

Only the original apheresis product will be cryopreserved, followingpreparation of a mononuclear cell preparation via ficoll densitygradient separation. The apheresis product will remain frozen in thevapor phase of liquid nitrogen for a short interval (expected to be lessthan 30 days) prior to thaw for manufacture of the DC vaccine.

Other Intermediate Holding Steps: All intermediate holding steps willoccur at 4-8° C.

In-Process Stability Testing: NA

Product Formulation to Patient Infusion: 5-15×10⁶/ml PlasmaLyte-A with1% HSA

Final Product Stability Testing:

Stability testing must be performed during early phases of the clinicaltrial to establish that the product is sufficiently stable for the timeperiod required by the study.

Shipping Conditions:

The product will be delivered by facility personnel from themanufacturing site to the clinical site, using validated,temperature-controlled shipping containers to demonstrate that productintegrity, sterility, and potency are maintained under the proposed 2-8°C. shipping conditions.

Product Tracking

For all products collected by or received in the Moffitt Cell TherapyFacility a unique component identification number is assigned whichallows tracking from the donor to the recipient or final distributionand from the recipient or final disposition to the donor.

Samples and aliquots of cellular therapy products used for testing arelabeled with the component number to permit tracking of the sample oraliquot to the cellular therapy product and/or person from whom it wastaken. There is a mechanism to identify the individual drawing thesample, the date, the time (where appropriate), and the sample source.

Every product processed by the Moffitt Cell Therapy Facility is linkedto the reagents' lot numbers and equipment used in said process. Thetechnologist responsible for each step of processing documents this inthe batch process record.

Labeling

Purpose: To ensure proper labeling and identification of cellulartherapy products for intermediate processing, storage and/ordistribution of products for autologous and allogeneic use. Labeling ofall products will be conducted in a manner to prevent mislabeling ormisidentification of cellular therapy products, samples, and associatedrecords.

In-Process Labeling:

Intermediate processing steps: During intermediate processing steps, apartial label will be used when transferring a product to a secondarycontainer and when samples are removed from the product for assays or QCtesting. The label will contain with the following:

Patient Name Medical Record Number Product Name

Unique alphanumeric accession numberDate of collection

“For Autologous Use Only” Final Product Labeling: Patient Name MedicalRecord Number Product Name

Unique alphanumeric accession number

Storage Temperature Expiration Date & Time Date of Product Manufacture“Caution: New Drug Limited by Federal Law to Investigational Use” “ForAutologous Use Only” Container Closure & Integrity

Final product will be transported from the Moffitt Cell Therapy Facilityto the Moffitt Infusion Center in a 1 ml syringe approved for clinicaluse. The syringe will be capped and placed in a plastic zip lock bag andlabeled as described.

Validation and Qualification of the Manufacturing Process QA/QC Program:Described in BB-MF 13743 Manufacturing Process Validation: Developmentand Optimization of Survivin Expressing Dendritic Cells

The development and optimization of production of mutant survivin(Ad-mS)-expressing DC was performed in multiple phases. These steps aredescribed below.

1. Titration of the Ad-mS Adenovirus

Ad-mS virus was purchased from Vivante GMP Solutions (now part of Lonza)and received in 2010. The vp/ml was provided by the company (1.10×10¹²vp/ml); however, the infectious units (IFU) were not determined and nofunctional testing was performed. The inventors titered the virus usingthe QuickTiter™ Adenovirus Titer Immunoassay Kit from CELL BIOLABS, INC.The working titer of the virus was found to be 7.90×10¹⁰ IFU/ml and wasused in all subsequent experiments.

2. Development of Survivin Detection Assay

Preliminary work using Ad-mS DC did not have a direct method fordetection of survivin expression. The inventors developed anintracellular flow cytometry assay to detect survivin expression. Thiswas compared to immunohistochemistry staining of DC.

3. Optimization of DC Infection

Our department has completed previous vaccine trials using DC infectedwith Adenovirus. This trial utilized 15,000 vp/DC; this viral dose isapproximately 1000 IFU/cell. That experience led us to infect DC with arange of Multiplicities of Infection (MOI; IFU/cell) centered on an MOIof 1000.Based on the results in FIG. 21, an MOI of 1000 will be used for futureexperiments.

Biostatistics NA PRECLINICAL STUDIES CLINICAL STUDIES Protocol Title:

Evaluating the Safety and Biological Activity of a Dendritic CellSurvivin Vaccine in Patients with Multiple Myeloma Undergoing AutologousHematopoietic Cell Transplantation

Subject Population:

Multiple Myeloma patients with survivin positive plasma cells on a bonemarrow biopsy

Route of Administration:

Intradermal injection to one site that will drain to one of the axillaryand/or inguinal lymph node basins

Dose:

5-15×10⁶ dendritic cells

Frequency:

One vaccine prior to autologous transplant and one vaccine postautologous transplant

Genetic, Biochemical, and Immunological Testing:

Determine CD4+ and CD8+ survivin specific T cell frequency before andafter vaccination.Analysis of INFγ producing T cells before and after vaccination.Measurement of anti-pneumococcal IgG antibody titers and T cellresponses against CRM adjuvant before and after vaccination.Evaluation of immunomodulatory phenotypes by T cell subsets before andafter vaccination.

-   1. Mesri M, Wall N R, Li J, Kim R W, Altieri D C. Cancer gene    therapy using a survivin mutant adenovirus. The Journal of clinical    investigation. 2001; 108(7):981-90.-   2. Luo J, Deng Z L, Luo X, Tang N, Song W X, Chen J, Sharff K A, Luu    H H, Haydon R C, Kinzler K W, Vogelstein B, He T C. A protocol for    rapid generation of recombinant adenoviruses using the AdEasy    system. Nature protocols. 2007; 2(5):1236-47.

EXEMPLIFIED EMBODIMENTS

Examples of embodiments of the invention include, but are not limitedto:

Embodiment 1

An antigen presenting cell comprising a variant survivin polypeptide, ora nucleic acid sequence encoding the variant survivin polypeptide,wherein the variant survivin polypeptide comprises at least consecutiveamino acids 16-87 (N-terminal zinc-binding baculovirus inhibitor ofapoptosis protein repeat (BIR) domain) of the human wild-type survivinpolypeptide (SEQ ID NO:1) modified to have an amino acid at position 34which is other than threonine and an amino acid at position 84 which isother than cysteine, relative to the human wild-type survivinpolypeptide, and wherein the variant survivin polypeptide:

(a) comprises a 142-amino acid sequence having at least 80% sequenceidentity to the human wild-type survivin polypeptide (SEQ ID NO:1), or

(b) is a subsequence (fragment) of the human wild-type survivinpolypeptide (SEQ ID NO:1).

Embodiment 2

The antigen presenting cell of embodiment 1, wherein one or both of theamino acids at position 34 and at position 84 are nonpolar amino acids.

Embodiment 3

The antigen presenting cell of embodiment 1, wherein one or both of theamino acids at position 34 and at position 84 are alanine.

Embodiment 4

The antigen presenting cell of any one of embodiments 1 to 3, whereinthe variant survivin polypeptide comprises the full-length humanwild-type survivin polypeptide having an amino acid at position 34 whichis other than threonine, and an amino acid at position 84 which is otherthan cysteine, as set forth as SEQ ID NO:2.

Embodiment 5

The antigen presenting of any one of embodiments 1 to 3, wherein thevariant survivin polypeptide further includes at least consecutive aminoacids 6-10, consecutive amino acids 89-97 (linker region), andconsecutive amino acids 97-141 (coiled coil domain) of the humanwild-type survivin polypeptide (SEQ ID NO:1).

Embodiment 6

The antigen presenting cell of any preceding embodiment, wherein theantigen presenting cell is a dendritic cell.

Embodiment 7

The antigen presenting cell of any preceding embodiment, wherein theantigen presenting cell is a human cell.

Embodiment 8

The antigen presenting cell of any preceding embodiment, wherein thevariant survivin polypeptide comprises the amino acid sequence of SEQ IDNO:2 or SEQ ID NO:3.

Embodiment 9

The antigen presenting cell of any preceding embodiment, wherein thevariant survivin polypeptide consists of the amino acid sequence of SEQID NO:2 or SEQ ID NO:3.

Embodiment 10

The antigen presenting cell of any preceding embodiment, whereinportions of the variant survivin polypeptide are presented on the cellsurface of the antigen presenting cell.

Embodiment 11

A composition comprising antigen presenting cells of any one ofembodiments 1 to 10; and a pharmaceutically acceptable carrier.

Embodiment 12

The composition of embodiment 11, further comprising an adjuvant.

Embodiment 13

The composition of embodiment 11, wherein the variant survivinpolypeptide comprises the amino acid sequence of SEQ ID NO:2 or SEQ IDNO:3.

Embodiment 14

The composition of embodiment 11, wherein the variant survivinpolypeptide comprises the amino acid sequence of SEQ ID NO:2 or SEQ IDNO:3.

Embodiment 15

A composition comprising a variant survivin polypeptide, or a nucleicacid sequence encoding the variant survivin polypeptide; and anadjuvant,

wherein the variant survivin polypeptide comprises at least consecutiveamino acids 16-87 (N-terminal zinc-binding baculovirus inhibitor ofapoptosis protein repeat (BIR) domain) of the human wild-type survivinpolypeptide (SEQ ID NO:1) modified to have an amino acid at position 34which is other than threonine and an amino acid at position 84 which isother than cysteine, relative to the human wild-type survivinpolypeptide, and wherein the variant survivin polypeptide:

(a) comprises a 142-amino acid sequence having at least 80% sequenceidentity to the human wild-type survivin polypeptide (SEQ ID NO:1), or

(b) is a subsequence (fragment) of the human wild-type survivinpolypeptide (SEQ ID NO:1).

Embodiment 16

The composition of embodiment 15, wherein the variant survivinpolypeptide comprises the amino acid sequence of SEQ ID NO:2 or SEQ IDNO:3.

Embodiment 17

The composition of embodiment 15, wherein the variant survivinpolypeptide consists of the amino acid sequence of SEQ ID NO:2 or SEQ IDNO:3.

Embodiment 18

A method for treating a malignancy, comprising administering to asubject in need of treatment an effective amount of:

(i) a variant survivin polypeptide, or

(ii) an expression construct comprising a nucleic acid sequence encodingthe variant survivin polypeptide, or

(iii) an antigen presenting cell comprising the variant survivinpolypeptide or the nucleic acid sequence encoding the variant survivinpolypeptide,

wherein the variant survivin polypeptide comprises at least consecutiveamino acids 16-87 (N-terminal zinc-binding baculovirus inhibitor ofapoptosis protein repeat (BIR) domain) of the human wild-type survivinpolypeptide (SEQ ID NO:1) modified to have an amino acid at position 34which is other than threonine and an amino acid at position 84 which isother than cysteine, relative to the human wild-type survivinpolypeptide, and wherein the variant survivin polypeptide:

(a) comprises a 142-amino acid sequence having at least 80% sequenceidentity to the human wild-type survivin polypeptide (SEQ ID NO:1), or

(b) is a subsequence (fragment) of the human wild-type survivinpolypeptide (SEQ ID NO:1).

Embodiment 19

The method of embodiment 18, wherein the antigen presenting cells arethose of any one of embodiments 1 to 10 or a composition of any one ofembodiments 11 to 17.

Embodiment 20

The method of embodiment 18 or 19, wherein the antigen presenting cellsare autologous cells.

Embodiment 21

The method of any one of embodiments 18 to 20, wherein the malignancy ismyeloma.

Embodiment 22

The method of any one of embodiments 18 to 21, wherein the methodfurther comprises administering one or more additional anti-canceragents to the subject.

Embodiment 23

The method of any one of embodiments 18 to 22, wherein the methodfurther comprises administering a chemotherapeutic drug (e.g.,melphalan), immunomodulator, adjuvant, anemia drug (e.g.,erythropoietin), radiation therapy, stem cell transplant, or acombination of two or more of the foregoing.

Embodiment 24

The method of any one of embodiments 18 to 23, wherein the method doesnot include administration of an anti-CD25 antibody.

Embodiment 25

The method of any one of embodiments 18 to 24, wherein the method doesnot include administration of a humanized IgG1 monoclonal antibody thatbinds specifically to the alpha subunit (p55 alpha, CD25, or Tacsubunit) of the human high-affinity interleukin-2 (IL-2) receptor.

Embodiment 26

The method of any one of embodiments 18 to 25, wherein the subject ishuman.

Embodiment 27

The method of any one of embodiments 18 to 26, wherein the antigenpresenting cells are administered by intradermal injection.

Embodiment 28

The method of embodiment 27, wherein the intradermal injection is at ananatomical site that drains to the axillary and/or inguinal lymph nodebasins of the subject.

Embodiment 29

The method of any one of embodiment 18, wherein the variant survivinpolypeptide, expression construct, or antigen presenting cells areadministered multiple times over a period of days.

Embodiment 30

The method of any one of embodiments 18 to 29, wherein the methodfurther comprises conducting hematopoietic cell transplantation(hematopoietic stem cells or progenitor cells, e.g., from bone marrow,peripheral blood, or cord blood) on the subject.

Embodiment 31

The method of embodiment 30, wherein the hematopoietic cell transplantis autologous.

Embodiment 32

The method of embodiment 30 or 31, wherein the antigen presenting cellsare administered before and after the hematopoietic celltransplantation.

Embodiment 33

The method of embodiment 30 or 31, further comprising conducting stemcell mobilization (e.g., using G-CSF) on the subject and collecting thehematopoietic cells from the subject prior to autologous hematopoieticcell transplantation.

Embodiment 34

The method of any one of embodiments 18 to 34, further comprising, priorto said administering, collecting mononuclear cells from the subject forproduction of the antigen presenting cells to be administered to thesubject.

Embodiment 35

The method of embodiment 34, wherein the antigen presenting cells arecryopreserved prior to said administering.

Embodiment 36

The method of any one of embodiments 18 to 35, further comprisingadministering a chemotherapeutic agent (e.g., melphalan) before, during,or after said administering of the variant survivin polypeptideexpression construct, or antigen presenting cells.

Embodiment 37

The method of embodiment 30, further comprising administering achemotherapeutic agent (e.g., melphalan) during the hematopoietic celltransplantation.

Embodiment 38

The method of any one of embodiments 18 to 37, wherein the variantsurvivin polypeptide comprises the amino acid sequence of SEQ ID NO:2 orSEQ ID NO:3.

Embodiment 39

The method of any one of embodiments 18 to 37, wherein the variantsurvivin polypeptide consists of the amino acid sequence of SEQ ID NO:2or SEQ ID NO:3.

Embodiment 40

A method for producing antigen presenting cells comprising a variantsurvivin polypeptide, or a nucleic acid sequence encoding the variantsurvivin polypeptide, comprising:

contacting antigen presenting cells or their precursors with a variantsurvivin polypeptide, or transfecting antigen presenting cells or theirprecursors with an expression construct comprising a nucleic acidsequence encoding a variant survivin polypeptide,

wherein the variant survivin polypeptide comprises at least consecutiveamino acids 16-87 (N-terminal zinc-binding baculovirus inhibitor ofapoptosis protein repeat (BIR) domain) of the human wild-type survivinpolypeptide (SEQ ID NO:1) modified to have an amino acid at position 34which is other than threonine and an amino acid at position 84 which isother than cysteine, relative to the human wild-type survivinpolypeptide, and wherein the variant survivin polypeptide:

(a) comprises a 142-amino acid sequence having at least 80% sequenceidentity to the human wild-type survivin polypeptide (SEQ ID NO:1), or

(b) is a subsequence (fragment) of the human wild-type survivinpolypeptide (SEQ ID NO:1).

Embodiment 41

The method of embodiment 40, wherein the expression construct is a viralvector, non-viral vector, or naked DNA.

Embodiment 42

The method of embodiment 40, wherein the expression construct is a viralvector selected from among adenovirus, adeno-associated virus, poxvirus,lentivirus, alphavirus, herpesvirus, retrovirus, and vaccina virus.

Embodiment 43

The method of any one of embodiments 40 to 42, wherein the methodfurther comprises, prior to said transfecting, obtaining mononuclearcells for the production of myeloid dendritic cells.

Embodiment 44

The method of embodiment 43, wherein the mononuclear cells are obtainedfrom a subject by apheresis.

Embodiment 45

The method of embodiment 43 or 44, wherein the mononuclear cells arecryopreserved before or after said transfecting.

Embodiment 46

The method of any one of embodiments 43 to 45, further comprisingculturing the cells in chemically defined, serum-free hematopoietic cellmedium, GM-CSF, and IL-4; and collecting the resulting antigenpresenting cells before said transfecting.

Embodiment 47

A method for inducing an immune response in a subject, comprisingadministering to the subject an effective amount of:

(i) a variant survivin polypeptide, or

(ii) an expression construct comprising a nucleic acid sequence encodingthe variant survivin polypeptide, or

(iii) an antigen presenting cell comprising the variant survivinpolypeptide or the nucleic acid sequence encoding the variant survivinpolypeptide,

wherein the variant survivin polypeptide comprises at least consecutiveamino acids 16-87 (N-terminal zinc-binding baculovirus inhibitor ofapoptosis protein repeat (BIR) domain) of the human wild-type survivinpolypeptide (SEQ ID NO:1) modified to have an amino acid at position 34which is other than threonine and an amino acid at position 84 which isother than cysteine, relative to the human wild-type survivinpolypeptide, and wherein the variant survivin polypeptide:

(a) comprises a 142-amino acid sequence having at least 80% sequenceidentity to the human wild-type survivin polypeptide (SEQ ID NO:1), or

(b) is a subsequence (fragment) of the human wild-type survivinpolypeptide (SEQ ID NO:1).

Embodiment 48

The method of embodiment 47, wherein the antigen presenting cells arethose of any one of embodiments 1 to 10 or a composition of any one ofembodiments 11 to 17.

Embodiment 49

The method of embodiment 47 or 48, wherein the variant survivinpolypeptide comprises the amino acid sequence of SEQ ID NO: 2 or SEQ IDNO:3.

Embodiment 50

The method of embodiment 47 or 48, wherein the variant survivinpolypeptide consists of the amino acid sequence of SEQ ID NO:2 or SEQ IDNO:3.

Embodiment 51

The method of any one of embodiments 47 to 50, wherein the subject hascancer.

Embodiment 52

The method of any one of embodiments 47 to 51, wherein the subject ishuman.

1. An antigen presenting cell comprising a variant survivin polypeptide,or a nucleic acid sequence encoding the variant survivin polypeptide,wherein the variant survivin polypeptide comprises at least consecutiveamino acids 16-87 (N-terminal zinc-binding baculovirus inhibitor ofapoptosis protein repeat (BIR) domain) of the human wild-type survivinpolypeptide (SEQ ID NO:1) modified to have an amino acid at position 34which is other than threonine and an amino acid at position 84 which isother than cysteine, relative to the human wild-type survivinpolypeptide, and wherein the variant survivin polypeptide: (a) comprisesa 142-amino acid sequence having at least 80% sequence identity to thehuman wild-type survivin polypeptide (SEQ ID NO:1), or (b) is asubsequence (fragment) of the human wild-type survivin polypeptide (SEQID NO:1).
 2. The antigen presenting cell of claim 1, wherein one or bothof the amino acids at position 34 and at position 84 are nonpolar aminoacids.
 3. The antigen presenting cell of claim 1, wherein one or both ofthe amino acids at position 34 and at position 84 are alanine.
 4. Theantigen presenting cell of claim 1, wherein the variant survivinpolypeptide comprises the full-length human wild-type survivinpolypeptide having an amino acid at position 34 which is other thanthreonine, and an amino acid at position 84 which is other thancysteine, as set forth as SEQ ID NO:2.
 5. The antigen presenting cell ofclaim 1, wherein the variant survivin polypeptide further includes atleast consecutive amino acids 6-10, consecutive amino acids 89-97(linker region), and consecutive amino acids 97-141 (coiled coil domain)of the human wild-type survivin polypeptide (SEQ ID NO:1).
 6. Theantigen presenting cell of claim 1, wherein the variant survivinpolypeptide comprises the amino acid sequence of SEQ ID NO:3.
 7. Theantigen presenting cell of claim 1, wherein portions of the variantsurvivin polypeptide are presented on the cell surface of the antigenpresenting cell.
 8. A composition comprising antigen presenting cells ofclaim 1; and a pharmaceutically acceptable carrier.
 9. The compositionof claim 8, further comprising an adjuvant.
 10. A composition comprisinga variant survivin polypeptide, or a nucleic acid sequence encoding thevariant survivin polypeptide; and an adjuvant, wherein the variantsurvivin polypeptide comprises at least consecutive amino acids 16-87(N-terminal zinc-binding baculovirus inhibitor of apoptosis proteinrepeat (BIR) domain) of the human wild-type survivin polypeptide (SEQ IDNO:1) modified to have an amino acid at position 34 which is other thanthreonine and an amino acid at position 84 which is other than cysteine,relative to the human wild-type survivin polypeptide, and wherein thevariant survivin polypeptide: (a) comprises a 142-amino acid sequencehaving at least 80% sequence identity to the human wild-type survivinpolypeptide (SEQ ID NO:1), or (b) is a subsequence (fragment) of thehuman wild-type survivin polypeptide (SEQ ID NO:1).
 11. A method fortreating a malignancy, comprising administering to a subject in need oftreatment an effective amount of: (i) a variant survivin polypeptide, or(ii) an expression construct comprising a nucleic acid sequence encodingthe variant survivin polypeptide, or (iii) an antigen presenting cellcomprising the variant survivin polypeptide or the nucleic acid sequenceencoding the variant survivin polypeptide, wherein the variant survivinpolypeptide comprises at least consecutive amino acids 16-87 (N-terminalzinc-binding baculovirus inhibitor of apoptosis protein repeat (BIR)domain) of the human wild-type survivin polypeptide (SEQ ID NO:1)modified to have an amino acid at position 34 which is other thanthreonine and an amino acid at position 84 which is other than cysteine,relative to the human wild-type survivin polypeptide, and wherein thevariant survivin polypeptide: (a) comprises a 142-amino acid sequencehaving at least 80% sequence identity to the human wild-type survivinpolypeptide (SEQ ID NO:1), or (b) is a subsequence (fragment) of thehuman wild-type survivin polypeptide (SEQ ID NO:1).
 12. The method ofclaim 11, wherein the antigen presenting cells are autologous cells. 13.The method of claim 11, wherein the malignancy is myeloma.
 14. Themethod of claim 11, wherein the method further comprises conductinghematopoietic cell transplantation on the subject.
 15. The method ofclaim 14, wherein the hematopoietic cell transplant is autologous. 16.The method of claim 11, wherein the variant survivin polypeptidecomprises the amino acid sequence of SEQ ID NO:2 or SEQ ID NO:3. 17-20.(canceled)